Provider Demographics
NPI:1871667220
Name:CLEAR VIEW OPTICAL, S.C.
Entity Type:Organization
Organization Name:CLEAR VIEW OPTICAL, S.C.
Other - Org Name:BAY VISION CLINIC, S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-743-8884
Mailing Address - Street 1:1236 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3819
Mailing Address - Country:US
Mailing Address - Phone:920-743-8884
Mailing Address - Fax:920-743-2519
Practice Address - Street 1:1236 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3819
Practice Address - Country:US
Practice Address - Phone:920-743-8884
Practice Address - Fax:920-743-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI582971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38720300Medicaid
WIDG8179Medicare PIN
WI000035157Medicare PIN
WI38720300Medicaid