Provider Demographics
NPI:1104408590
Name:FITCHBURG FAMILY EYE CARE LLC
Entity type:Organization
Organization Name:FITCHBURG FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JINGPING
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-235-8472
Mailing Address - Street 1:2797 LEO MARY ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-9305
Mailing Address - Country:US
Mailing Address - Phone:502-235-8472
Mailing Address - Fax:
Practice Address - Street 1:6635 MCKEE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5023
Practice Address - Country:US
Practice Address - Phone:608-299-9777
Practice Address - Fax:608-299-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-25
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty