Provider Demographics
NPI:1780839910
Name:HALE IRELAND, SC
Entity Type:Organization
Organization Name:HALE IRELAND, SC
Other - Org Name:HALE IRELAND LASER & IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-789-9029
Mailing Address - Street 1:20350 WATER TOWER BLVD
Mailing Address - Street 2:200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3558
Mailing Address - Country:US
Mailing Address - Phone:262-789-9029
Mailing Address - Fax:262-789-0676
Practice Address - Street 1:20350 WATER TOWER BLVD
Practice Address - Street 2:200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-3558
Practice Address - Country:US
Practice Address - Phone:262-789-9029
Practice Address - Fax:262-789-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42239207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty