Provider Demographics
NPI:1013070820
Name:ORLICH OPHTHALMIC CONSULTING S.C.
Entity Type:Organization
Organization Name:ORLICH OPHTHALMIC CONSULTING S.C.
Other - Org Name:HOLMEN EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:ORLICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-526-1177
Mailing Address - Street 1:106 S HOLMEN DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9467
Mailing Address - Country:US
Mailing Address - Phone:608-526-1177
Mailing Address - Fax:608-526-4131
Practice Address - Street 1:106 S HOLMEN DR
Practice Address - Street 2:SUITE 6
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9467
Practice Address - Country:US
Practice Address - Phone:608-526-1177
Practice Address - Fax:608-526-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38505100Medicaid
WIU30274Medicare UPIN