Provider Demographics
NPI:1508117151
Name:EYECARE CENTER OF MADISON PROF LLC
Entity Type:Organization
Organization Name:EYECARE CENTER OF MADISON PROF LLC
Other - Org Name:EYECARE CENTER OF MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-256-6911
Mailing Address - Street 1:302 N HARTH AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 N HARTH AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2219
Practice Address - Country:US
Practice Address - Phone:605-256-6911
Practice Address - Fax:605-256-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty