Provider Demographics
NPI:1528829405
Name:PEAK EYE CARE, SC
Entity type:Organization
Organization Name:PEAK EYE CARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAGENAIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-490-8000
Mailing Address - Street 1:3670 S 108TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1237
Mailing Address - Country:US
Mailing Address - Phone:414-452-1010
Mailing Address - Fax:414-425-4250
Practice Address - Street 1:3670 S 108TH ST STE 204
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1237
Practice Address - Country:US
Practice Address - Phone:414-452-1010
Practice Address - Fax:414-425-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty