Provider Demographics
NPI:1467829523
Name:EYE-Q OPTICAL
Entity Type:Organization
Organization Name:EYE-Q OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSHA, ABOC
Authorized Official - Phone:262-261-5252
Mailing Address - Street 1:309 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1905
Mailing Address - Country:US
Mailing Address - Phone:262-261-5252
Mailing Address - Fax:262-649-2310
Practice Address - Street 1:309 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1905
Practice Address - Country:US
Practice Address - Phone:262-261-5252
Practice Address - Fax:262-649-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2716-35152W00000X
WI184443156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407233430Medicaid