Provider Demographics
NPI:1265513410
Name:EYE CARE CENTERS OF WISCONSIN, S.C.
Entity type:Organization
Organization Name:EYE CARE CENTERS OF WISCONSIN, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HAMMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-922-7121
Mailing Address - Street 1:355 N PETERS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8115
Mailing Address - Country:US
Mailing Address - Phone:920-922-7121
Mailing Address - Fax:920-922-5666
Practice Address - Street 1:355 N PETERS AVE STE 1
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8115
Practice Address - Country:US
Practice Address - Phone:920-922-7121
Practice Address - Fax:920-922-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1471-035152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0597650001Medicare NSC