Provider Demographics
NPI:1710289608
Name:EARL W NEPPLE M.D.
Entity Type:Organization
Organization Name:EARL W NEPPLE M.D.
Other - Org Name:CLEAR VISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NEPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-338-0199
Mailing Address - Street 1:1201 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3800
Mailing Address - Country:US
Mailing Address - Phone:262-338-0199
Mailing Address - Fax:
Practice Address - Street 1:1201 OAK ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3800
Practice Address - Country:US
Practice Address - Phone:262-338-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19896332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30430500Medicaid
WI30430500Medicaid
WI67019Medicare PIN
WI0935730001Medicare NSC