Provider Demographics
NPI:1699974980
Name:EYE ASSOCIATES OF GREEN BAY, SC
Entity type:Organization
Organization Name:EYE ASSOCIATES OF GREEN BAY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JILOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-965-4800
Mailing Address - Street 1:2020 RIVERSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2300
Mailing Address - Country:US
Mailing Address - Phone:920-965-7000
Mailing Address - Fax:920-965-4701
Practice Address - Street 1:2020 RIVERSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2300
Practice Address - Country:US
Practice Address - Phone:920-965-7000
Practice Address - Fax:920-965-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000007100OtherMEDICARE GROUP
WI32899700OtherWMAP GROUP
WI4334090001OtherADMINASTAR FEDERAL REGION
WICJ2796OtherMEDICARE RR GROUP
WI000007100OtherMEDICARE GROUP