1235277427 NPI number — WISCONSIN VISION, INC

Table of content: (NPI 1235277427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235277427 NPI number — WISCONSIN VISION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN VISION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235277427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16800 WEST CLEVELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERLIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53151-3533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-432-2005
Provider Business Mailing Address Fax Number:
262-432-2006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4818 S 76TH ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53220-4362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-431-0385
Provider Business Practice Location Address Fax Number:
414-431-0386
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HORNDASCH
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
262-432-2005

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)