Provider Demographics
NPI:1063740637
Name:BROOKFIELD SIGHTLAB, LTD
Entity type:Organization
Organization Name:BROOKFIELD SIGHTLAB, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-754-0860
Mailing Address - Street 1:20350 WATER TOWER BLVD
Mailing Address - Street 2:200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3558
Mailing Address - Country:US
Mailing Address - Phone:262-754-0860
Mailing Address - Fax:262-789-0676
Practice Address - Street 1:20350 WATER TOWER BLVD
Practice Address - Street 2:200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-3558
Practice Address - Country:US
Practice Address - Phone:262-754-0860
Practice Address - Fax:262-789-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical