Provider Demographics
NPI:1609040146
Name:WAUKESHA EYE ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:WAUKESHA EYE ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-542-0860
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-542-0860
Mailing Address - Fax:262-542-5428
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 314
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-542-0860
Practice Address - Fax:262-542-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19016261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICS1332OtherRR MEDICARE
WI=========018OtherBLUE CROSS/ BLUE SHEILD
WI=========018OtherBLUE CROSS/ BLUE SHEILD
WICS1332OtherRR MEDICARE