Provider Demographics
NPI:1578705919
Name:FIRST EYECARE, PC
Entity Type:Organization
Organization Name:FIRST EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SAEID
Authorized Official - Last Name:ENVANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-695-3191
Mailing Address - Street 1:108 S REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-9240
Mailing Address - Country:US
Mailing Address - Phone:262-695-3191
Mailing Address - Fax:262-695-3806
Practice Address - Street 1:411 PEWAUKEE RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5886
Practice Address - Country:US
Practice Address - Phone:262-695-3191
Practice Address - Fax:262-695-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2579-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty