Provider Demographics
NPI:1083988620
Name:ULTIMATE EYE CARE LLC
Entity Type:Organization
Organization Name:ULTIMATE EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-495-8074
Mailing Address - Street 1:53 W TOWNE MALL
Mailing Address - Street 2:SEARS OPTICAL
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1019
Mailing Address - Country:US
Mailing Address - Phone:608-829-3041
Mailing Address - Fax:608-833-0754
Practice Address - Street 1:53 W TOWNE MALL
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1019
Practice Address - Country:US
Practice Address - Phone:608-829-3041
Practice Address - Fax:608-833-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI324735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty