Provider Demographics
NPI:1962620633
Name:MILWAUKEE EYE CARE ASSOCIATES S.C.
Entity type:Organization
Organization Name:MILWAUKEE EYE CARE ASSOCIATES S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KANG
Authorized Official - Middle Name:B
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-271-2020
Mailing Address - Street 1:1684 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2408
Mailing Address - Country:US
Mailing Address - Phone:414-271-2020
Mailing Address - Fax:414-272-3932
Practice Address - Street 1:17280 W NORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4366
Practice Address - Country:US
Practice Address - Phone:414-271-2020
Practice Address - Fax:262-786-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0576850002Medicare PIN