Provider Demographics
NPI:1578027884
Name:BAYSHORE VISION, LLC
Entity Type:Organization
Organization Name:BAYSHORE VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-659-2015
Mailing Address - Street 1:N72W8057 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1750
Mailing Address - Country:US
Mailing Address - Phone:414-659-2015
Mailing Address - Fax:
Practice Address - Street 1:420 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5047
Practice Address - Country:US
Practice Address - Phone:414-962-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty