Provider Demographics
NPI:1669093308
Name:EYE PHYSICIANS & SURGEONS SC
Entity type:Organization
Organization Name:EYE PHYSICIANS & SURGEONS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAHLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-723-4600
Mailing Address - Street 1:1311 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4375
Mailing Address - Country:US
Mailing Address - Phone:262-723-4600
Mailing Address - Fax:262-723-4710
Practice Address - Street 1:675 W STATE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1739
Practice Address - Country:US
Practice Address - Phone:262-763-7772
Practice Address - Fax:262-947-4996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE PHYSICIANS & SURGEONS SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-05
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty