Provider Demographics
NPI:1851577829
Name:EYE CLINIC SC
Entity Type:Organization
Organization Name:EYE CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:WILLIM
Authorized Official - Last Name:VEITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-248-8577
Mailing Address - Street 1:7363 STATE ROAD 50
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4516
Mailing Address - Country:US
Mailing Address - Phone:262-248-8577
Mailing Address - Fax:262-248-8757
Practice Address - Street 1:7363 STATE ROAD 50
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4516
Practice Address - Country:US
Practice Address - Phone:262-248-8577
Practice Address - Fax:262-248-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18321305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization