Provider Demographics
NPI:1093990855
Name:BROOKFIELD VISION CENTER, S.C.
Entity Type:Organization
Organization Name:BROOKFIELD VISION CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-754-4880
Mailing Address - Street 1:19035 W CAPITOL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2755
Mailing Address - Country:US
Mailing Address - Phone:262-754-4880
Mailing Address - Fax:262-754-9814
Practice Address - Street 1:19035 W CAPITOL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2755
Practice Address - Country:US
Practice Address - Phone:262-754-4880
Practice Address - Fax:262-754-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty