Provider Demographics
NPI:1578554390
Name:ISTHMUS EYE CARE SC
Entity Type:Organization
Organization Name:ISTHMUS EYE CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-831-3366
Mailing Address - Street 1:7601 UNIVERSITY AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5414
Mailing Address - Country:US
Mailing Address - Phone:608-831-3366
Mailing Address - Fax:608-831-8470
Practice Address - Street 1:7601 UNIVERSITY AVE
Practice Address - Street 2:STE 102
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5414
Practice Address - Country:US
Practice Address - Phone:608-831-3366
Practice Address - Fax:608-831-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38723000Medicaid
WI38723000Medicaid
WI0299420002Medicare NSC