Provider Demographics
NPI:1710084397
Name:CLEAR VIEW OPTICAL INC.
Entity Type:Organization
Organization Name:CLEAR VIEW OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:BEIERLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:920-743-1340
Mailing Address - Street 1:1236 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3819
Mailing Address - Country:US
Mailing Address - Phone:920-743-1340
Mailing Address - Fax:920-743-1340
Practice Address - Street 1:1236 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3819
Practice Address - Country:US
Practice Address - Phone:920-743-1340
Practice Address - Fax:920-743-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38441300Medicaid
WI38441300Medicaid