Provider Demographics
NPI:1609869858
Name:MILWAUKEE EYE CARE ASSOCIATES S.C.
Entity Type:Organization
Organization Name:MILWAUKEE EYE CARE ASSOCIATES S.C.
Other - Org Name:FOOTE LASER VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-271-2020
Mailing Address - Street 1:1684 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2408
Mailing Address - Country:US
Mailing Address - Phone:414-271-2020
Mailing Address - Fax:
Practice Address - Street 1:1684 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2408
Practice Address - Country:US
Practice Address - Phone:414-271-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0000002560OtherDMERC PIN
WI38711800Medicaid
WI0000002560OtherDMERC PIN
WI38711800Medicaid
WI000002650Medicare PIN