Provider Demographics
NPI:1174636922
Name:OPTICAL CONSULTANTS, INC
Entity Type:Organization
Organization Name:OPTICAL CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:POETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-521-9383
Mailing Address - Street 1:2315 SILVERNAIL RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5402
Mailing Address - Country:US
Mailing Address - Phone:262-521-9383
Mailing Address - Fax:262-521-9484
Practice Address - Street 1:2315 SILVERNAIL RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5402
Practice Address - Country:US
Practice Address - Phone:262-521-9383
Practice Address - Fax:262-521-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIN/A156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000087995Medicare PIN
WIU35166Medicare UPIN
WI0908930001Medicare NSC