Provider Demographics
NPI:1124450168
Name:MEDICAL EYE ASSOCIATES, S.C.
Entity type:Organization
Organization Name:MEDICAL EYE ASSOCIATES, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-547-3352
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-3352
Mailing Address - Fax:
Practice Address - Street 1:400 BAY VIEW RD
Practice Address - Street 2:SUITE D
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1770
Practice Address - Country:US
Practice Address - Phone:262-363-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL EYE ASSOCIATES, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-01
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0397710001Medicare PIN