Provider Demographics
NPI:1467664680
Name:EYE SITE VISION CARE CENTER INC
Entity Type:Organization
Organization Name:EYE SITE VISION CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTISI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-786-2020
Mailing Address - Street 1:15425 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5156
Mailing Address - Country:US
Mailing Address - Phone:262-789-6929
Mailing Address - Fax:262-789-1432
Practice Address - Street 1:15425 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5156
Practice Address - Country:US
Practice Address - Phone:262-789-6929
Practice Address - Fax:262-789-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU-30939Medicare UPIN
WITO1415Medicare UPIN