Provider Demographics
NPI:1871655787
Name:REGNER FAMILY VISION CLINIC, S.C.
Entity Type:Organization
Organization Name:REGNER FAMILY VISION CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REGNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-694-9103
Mailing Address - Street 1:4014 77TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4314
Mailing Address - Country:US
Mailing Address - Phone:262-694-9103
Mailing Address - Fax:262-694-9106
Practice Address - Street 1:4014 77TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4314
Practice Address - Country:US
Practice Address - Phone:262-694-9103
Practice Address - Fax:262-694-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1356-035332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000132465Medicare ID - Type Unspecified
WIT63079Medicare UPIN