Provider Demographics
NPI:1043386600
Name:OPTIVISION EYE CARE LLP
Entity type:Organization
Organization Name:OPTIVISION EYE CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-364-9213
Mailing Address - Street 1:223 S NICOLET RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3938
Mailing Address - Country:US
Mailing Address - Phone:920-364-9213
Mailing Address - Fax:920-733-5151
Practice Address - Street 1:223 S NICOLET RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3938
Practice Address - Country:US
Practice Address - Phone:920-733-5888
Practice Address - Fax:920-733-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5364710001Medicare ID - Type Unspecified