Provider Demographics
NPI:1447377148
Name:EYE & VISION CLINICS, S.C.
Entity type:Organization
Organization Name:EYE & VISION CLINICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-845-5555
Mailing Address - Street 1:140 SCHOOL CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:LUXEMBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54217-1095
Mailing Address - Country:US
Mailing Address - Phone:920-845-5555
Mailing Address - Fax:920-845-5219
Practice Address - Street 1:140 SCHOOL CREEK TRL
Practice Address - Street 2:
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-1095
Practice Address - Country:US
Practice Address - Phone:920-845-5555
Practice Address - Fax:920-845-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1194812099OtherNPI FOR MATTHEW L NELSON
WI1003927278OtherNPI FOR DAVID R DUFECK
WI1790731743OtherNPI FOR TIMOTHY J CORGAN
WI1881711588OtherNPI FOR DEPERE CLINIC
WI1194812099OtherNPI FOR MATTHEW L NELSON
WI1790731743OtherNPI FOR TIMOTHY J CORGAN