Provider Demographics
NPI:1366560385
Name:MEDICAL EYE ASSOCIATES, S.C.
Entity type:Organization
Organization Name:MEDICAL EYE ASSOCIATES, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OWINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-828-2012
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-547-3352
Mailing Address - Fax:262-547-9142
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 312
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-547-3352
Practice Address - Fax:262-547-9142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL EYE ASSOCIATES, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44407156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI513382OtherNVA
WI927127OtherVIPA
WI513382OtherNVA