Provider Demographics
NPI:1336855055
Name:AURORA HEALTH CARE VENTURES, INC.
Entity Type:Organization
Organization Name:AURORA HEALTH CARE VENTURES, INC.
Other - Org Name:AURORA VISION CENTER - CALEDONIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-299-1610
Mailing Address - Street 1:5333 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2032
Mailing Address - Country:US
Mailing Address - Phone:262-752-2150
Mailing Address - Fax:262-752-2122
Practice Address - Street 1:5333 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-2032
Practice Address - Country:US
Practice Address - Phone:262-752-2150
Practice Address - Fax:262-752-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100228636Medicaid