1427347822 NPI number — EYE PHYSICIAN ASSOCIATES, S.C.

Table of content: (NPI 1427347822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427347822 NPI number — EYE PHYSICIAN ASSOCIATES, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE PHYSICIAN ASSOCIATES, S.C.
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:
EYE PHYSICIAN ASSOCIATES, S.C.
Provider Other Organization Name Type Code:
3
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:
1427347822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 W. LAYTON AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53220-4136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-260-0789
Provider Business Mailing Address Fax Number:
414-210-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1249 W LIEBAU RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-3396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-243-3001
Provider Business Practice Location Address Fax Number:
262-243-3006
Provider Enumeration Date:
04/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
YANG
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-928-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  3427120 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 4492620 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 4839520 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 3867120 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38616200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38632200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000046037 . This is a "OZAUKEE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 100189991 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32735700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73605 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1851590343 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34678800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38622400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C017777 . This is a "RR MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 124580001 . This is a "DMEPOS ASSIGNED" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32306500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34249800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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