Provider Demographics
NPI:1578609095
Name:EYE CARE OPTICAL INC.
Entity Type:Organization
Organization Name:EYE CARE OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEROPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-334-2020
Mailing Address - Street 1:1411 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4936
Mailing Address - Country:US
Mailing Address - Phone:262-334-2020
Mailing Address - Fax:262-334-0094
Practice Address - Street 1:1411 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4931
Practice Address - Country:US
Practice Address - Phone:262-334-2020
Practice Address - Fax:262-334-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0262070001Medicare NSC
WI000087905Medicare PIN