1457331894 NPI number — EYE PHYSICIAN ASSOCIATES, S.C.

Table of content: (NPI 1457331894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457331894 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:
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:
1457331894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2024
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:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53220-5132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-928-2020
Provider Business Mailing Address Fax Number:
414-210-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 W. LAYTON AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53220-5132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-928-2020
Provider Business Practice Location Address Fax Number:
414-210-3402
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32735700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38622400 , 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: ========= . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34678800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C01777 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000073822 . This is a "MILWAUKEE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "BLUE CROSS" 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: 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".
  • Identifier: ========= . This is a "COMPCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0264580001 . This is a "DMEPOS ASSIGNED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 73605 . This is a "WISCONSIN PHYSICIAN SERVI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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