Provider Demographics
NPI:1154456093
Name:MAGIERA EYECARE LLC
Entity type:Organization
Organization Name:MAGIERA EYECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGIERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-766-2481
Mailing Address - Street 1:1 BANK AVE
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2576
Mailing Address - Country:US
Mailing Address - Phone:920-766-2481
Mailing Address - Fax:920-766-3769
Practice Address - Street 1:1 BANK AVE
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2576
Practice Address - Country:US
Practice Address - Phone:920-766-2481
Practice Address - Fax:920-766-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38700400Medicaid
WI38700400Medicaid
ME0093182OtherDEA
WIMM1000695OtherDEA
WI38700400Medicaid
0191750001Medicare NSC
DG4363Medicare PIN