Provider Demographics
NPI:1609298876
Name:CAPITOL EYECARE, SC
Entity type:Organization
Organization Name:CAPITOL EYECARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-449-3353
Mailing Address - Street 1:1719 MONROE ST
Mailing Address - Street 2:SUITE 001
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1211
Practice Address - Country:US
Practice Address - Phone:608-449-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty