Provider Demographics
NPI:1427347822
Name:EYE PHYSICIAN ASSOCIATES, S.C.
Entity type:Organization
Organization Name:EYE PHYSICIAN ASSOCIATES, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-928-2020
Mailing Address - Street 1:4300 W. LAYTON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4136
Mailing Address - Country:US
Mailing Address - Phone:414-260-0789
Mailing Address - Fax:414-210-3402
Practice Address - Street 1:1249 W LIEBAU RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3396
Practice Address - Country:US
Practice Address - Phone:262-243-3001
Practice Address - Fax:262-243-3006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE PHYSICIAN ASSOCIATES (OPTICAL)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3427120207W00000X
WI4492620207W00000X
WI4839520207W00000X, 207W00000X
WI3867120207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38616200Medicaid
WI38632200Medicaid
WI000046037OtherOZAUKEE PTAN
WI100189991Medicaid
WI32735700Medicaid
73605OtherWPS
WI1851590343Medicaid
WI34678800Medicaid
WI38622400Medicaid
WIC017777OtherRR MEDICARE
WI124580001OtherDMEPOS ASSIGNED
WI32306500Medicaid
WI34249800Medicaid