Provider Demographics
NPI:1962653485
Name:SUSSEX EYE CARE CENTER SC
Entity Type:Organization
Organization Name:SUSSEX EYE CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-246-8066
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-0144
Mailing Address - Country:US
Mailing Address - Phone:262-246-8066
Mailing Address - Fax:262-246-9600
Practice Address - Street 1:N63W23524 SILVER SPRING DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3833
Practice Address - Country:US
Practice Address - Phone:262-246-8066
Practice Address - Fax:262-246-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1141580001Medicare NSC