Provider Demographics
NPI:1255477386
Name:FORESIGHT OPTICAL INC
Entity type:Organization
Organization Name:FORESIGHT OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-694-2400
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:N91 W20810 HILLVIEW DR.
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53052-1298
Mailing Address - Country:US
Mailing Address - Phone:414-915-3526
Mailing Address - Fax:
Practice Address - Street 1:7532 PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4316
Practice Address - Country:US
Practice Address - Phone:262-694-3400
Practice Address - Fax:262-694-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILICENSE NOT REQUIRED332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0830760001Medicare ID - Type UnspecifiedDURABLE GOODS NUMBER