Provider Demographics
NPI:1427563063
Name:REVISION EYE CARE, LLC
Entity Type:Organization
Organization Name:REVISION EYE CARE, LLC
Other - Org Name:MICHAEL J. DOWNS (DOWNS EYE CARE)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-423-5353
Mailing Address - Street 1:3341 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6566
Mailing Address - Country:US
Mailing Address - Phone:715-423-5353
Mailing Address - Fax:715-423-6525
Practice Address - Street 1:3341 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6566
Practice Address - Country:US
Practice Address - Phone:715-423-5353
Practice Address - Fax:715-423-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100078371Medicaid