Provider Demographics
NPI:1457331894
Name:EYE PHYSICIAN ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:EYE PHYSICIAN ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-928-2020
Mailing Address - Street 1:4300 W. LAYTON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-5132
Mailing Address - Country:US
Mailing Address - Phone:414-928-2020
Mailing Address - Fax:414-210-3402
Practice Address - Street 1:4300 W. LAYTON AVE
Practice Address - Street 2:STE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-5132
Practice Address - Country:US
Practice Address - Phone:414-928-2020
Practice Address - Fax:414-210-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherHUMANA
WI38632200Medicaid
0264580001OtherDMEPOS ASSIGNED
WI32306500Medicaid
WI34678800Medicaid
WI38622400Medicaid
WI=========OtherCOMPCARE
C01777OtherRAILROAD MEDICARE
WI000073822OtherMILWAUKEE PTAN
WI32735700Medicaid
WI34249800Medicaid
WI73605OtherWISCONSIN PHYSICIAN SERVI
WI=========OtherBLUE CROSS
WI100189991Medicaid
=========OtherUNITED HEALTH CARE
WI000046037Medicare ID - Type Unspecified
WI0264580002Medicare NSC
C01777OtherRAILROAD MEDICARE
WI38632200Medicaid