Provider Demographics
NPI:1588784979
Name:JORGENSEN, SCHULZ AND ASSOCIATES EYECARE CENTER, SC
Entity type:Organization
Organization Name:JORGENSEN, SCHULZ AND ASSOCIATES EYECARE CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-731-2020
Mailing Address - Street 1:1225 W NORTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1416
Mailing Address - Country:US
Mailing Address - Phone:920-731-2020
Mailing Address - Fax:920-733-2117
Practice Address - Street 1:1225 W NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1416
Practice Address - Country:US
Practice Address - Phone:920-731-2020
Practice Address - Fax:920-733-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000047260Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER