Provider Demographics
NPI:1013007475
Name:BRIGHT SIDE EYE CARE, S.C.
Entity Type:Organization
Organization Name:BRIGHT SIDE EYE CARE, S.C.
Other - Org Name:BRIGHT SIDE EYE CARE, S.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-835-3579
Mailing Address - Street 1:185 W NETHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1100
Mailing Address - Country:US
Mailing Address - Phone:608-835-3579
Mailing Address - Fax:608-835-5828
Practice Address - Street 1:185 W NETHERWOOD RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1100
Practice Address - Country:US
Practice Address - Phone:608-835-3579
Practice Address - Fax:608-835-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38614500Medicaid
WI38508900Medicaid
WI38508900Medicaid
WI000047137Medicare ID - Type Unspecified
WI38614500Medicaid