Provider Demographics
NPI:1033262589
Name:JAMES E. MEMMEN, M.D. LIMITED
Entity Type:Organization
Organization Name:JAMES E. MEMMEN, M.D. LIMITED
Other - Org Name:GREEN APPLE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MEMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-497-0100
Mailing Address - Street 1:PO BOX 10946
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-0946
Mailing Address - Country:US
Mailing Address - Phone:920-380-0100
Mailing Address - Fax:920-380-0101
Practice Address - Street 1:1543 PARK PL STE 400
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1970
Practice Address - Country:US
Practice Address - Phone:920-497-0100
Practice Address - Fax:920-497-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29183-020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356367023OtherNPI #
WI207W00000XOtherPROVIDER TAXONOMIES
WI29183-020OtherSTATE LICENSE
WI31395200Medicaid
WI207W00000XOtherPROVIDER TAXONOMIES