Provider Demographics
NPI:1902103369
Name:JOHN W THORPE OPTOMETRISTS SC
Entity type:Organization
Organization Name:JOHN W THORPE OPTOMETRISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-784-6446
Mailing Address - Street 1:14145 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151
Mailing Address - Country:US
Mailing Address - Phone:262-784-6446
Mailing Address - Fax:
Practice Address - Street 1:14145 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1640
Practice Address - Country:US
Practice Address - Phone:262-784-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI1362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38503900Medicaid
WIT63514Medicare UPIN
WI87769Medicare PIN