Provider Demographics
NPI:1245661875
Name:FOX VALLEY FAMILY EYE CARE SC
Entity type:Organization
Organization Name:FOX VALLEY FAMILY EYE CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-788-4162
Mailing Address - Street 1:607 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1856
Mailing Address - Country:US
Mailing Address - Phone:920-788-4162
Mailing Address - Fax:920-788-6134
Practice Address - Street 1:607 WILSON ST
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-1856
Practice Address - Country:US
Practice Address - Phone:920-788-4162
Practice Address - Fax:920-788-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2839-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty