Provider Demographics
NPI:1083644900
Name:PAYE EYE CARE CENTER SC
Entity Type:Organization
Organization Name:PAYE EYE CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-499-2147
Mailing Address - Street 1:1515 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2272
Mailing Address - Country:US
Mailing Address - Phone:920-499-2147
Mailing Address - Fax:920-499-0574
Practice Address - Street 1:1515 SIXTH ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2272
Practice Address - Country:US
Practice Address - Phone:920-499-2147
Practice Address - Fax:920-499-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1546035152W00000X
WI2511035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T62971Medicare UPIN
471640001Medicare PIN
WI0314920001Medicare NSC
471640002Medicare PIN
U70310Medicare UPIN