Provider Demographics
NPI:1427106129
Name:CEDAR CREEK EYE ASSCIATES, LLC
Entity type:Organization
Organization Name:CEDAR CREEK EYE ASSCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:CONTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-376-1800
Mailing Address - Street 1:5009 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9189
Mailing Address - Country:US
Mailing Address - Phone:262-376-1800
Mailing Address - Fax:262-376-1800
Practice Address - Street 1:5009 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9189
Practice Address - Country:US
Practice Address - Phone:262-376-1800
Practice Address - Fax:262-376-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2917-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty