Provider Demographics
NPI:1609944859
Name:NEHS FAMILY VISION CENTER, INC.
Entity Type:Organization
Organization Name:NEHS FAMILY VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KINSEY
Authorized Official - Last Name:NEHS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-542-3676
Mailing Address - Street 1:100 ARCADIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5002
Mailing Address - Country:US
Mailing Address - Phone:262-542-3676
Mailing Address - Fax:262-542-3826
Practice Address - Street 1:100 ARCADIAN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5002
Practice Address - Country:US
Practice Address - Phone:262-542-3676
Practice Address - Fax:262-542-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1260-065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4815400001Medicare NSC
WIT62847Medicare UPIN
WI000047595Medicare PIN