Provider Demographics
NPI:1205454626
Name:EYE SURGERY CENTER OF WISCONSIN, LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-889-2040
Mailing Address - Street 1:10148 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-5528
Mailing Address - Country:US
Mailing Address - Phone:414-377-9000
Mailing Address - Fax:
Practice Address - Street 1:10148 S 27TH ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-5528
Practice Address - Country:US
Practice Address - Phone:414-377-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical