Provider Demographics
NPI:1790905073
Name:NORTHEAST WISCONSIN VISION CENTER, LTD
Entity Type:Organization
Organization Name:NORTHEAST WISCONSIN VISION CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-232-6550
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903-2723
Mailing Address - Country:US
Mailing Address - Phone:920-232-6550
Mailing Address - Fax:
Practice Address - Street 1:1885 WEST POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4174
Practice Address - Country:US
Practice Address - Phone:920-232-6550
Practice Address - Fax:920-232-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
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
1289660001Medicare NSC