Provider Demographics
NPI:1508042730
Name:GERAETS VISION CENTER, INC
Entity Type:Organization
Organization Name:GERAETS VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALISSI
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:608-758-2020
Mailing Address - Street 1:2704 N PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0343
Mailing Address - Country:US
Mailing Address - Phone:608-758-2020
Mailing Address - Fax:608-755-7604
Practice Address - Street 1:2704 N PONTIAC DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0343
Practice Address - Country:US
Practice Address - Phone:608-758-2020
Practice Address - Fax:608-755-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38520300Medicaid
WI000047248Medicare PIN
WI4483300001Medicare NSC
WIU30941Medicare UPIN
WI38520300Medicaid