Provider Demographics
NPI:1043859341
Name:SITE 4 EYES
Entity type:Organization
Organization Name:SITE 4 EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-855-0469
Mailing Address - Street 1:7245 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9041
Mailing Address - Country:US
Mailing Address - Phone:414-855-0469
Mailing Address - Fax:
Practice Address - Street 1:7245 S 76TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9041
Practice Address - Country:US
Practice Address - Phone:414-855-0469
Practice Address - Fax:414-855-0492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KA CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-03
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty