Provider Demographics
NPI:1033239801
Name:EYE WEAR DESIGNS OF MARSHFIELD LLC
Entity Type:Organization
Organization Name:EYE WEAR DESIGNS OF MARSHFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-848-2020
Mailing Address - Street 1:117 W UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1458
Mailing Address - Country:US
Mailing Address - Phone:715-387-2773
Mailing Address - Fax:715-387-2773
Practice Address - Street 1:117 W UPHAM ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1458
Practice Address - Country:US
Practice Address - Phone:715-387-2773
Practice Address - Fax:715-387-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6207470001Medicare NSC
WIU67557Medicare UPIN