Provider Demographics
NPI:1992350375
Name:SUMMIT EYE CARE OF WISCONSIN SC
Entity type:Organization
Organization Name:SUMMIT EYE CARE OF WISCONSIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VUKICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-877-6414
Mailing Address - Street 1:10425 W NORTH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2400
Mailing Address - Country:US
Mailing Address - Phone:414-877-6414
Mailing Address - Fax:414-386-5245
Practice Address - Street 1:10425 W NORTH AVE STE 245
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2416
Practice Address - Country:US
Practice Address - Phone:414-877-6414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty