Provider Demographics
NPI:1811132830
Name:MODERN EYES LTD.
Entity type:Organization
Organization Name:MODERN EYES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:WASCHBISCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-499-3937
Mailing Address - Street 1:2330 S ONEIDA ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5118
Mailing Address - Country:US
Mailing Address - Phone:920-499-3937
Mailing Address - Fax:920-499-7729
Practice Address - Street 1:2330 S ONEIDA ST STE 106
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5118
Practice Address - Country:US
Practice Address - Phone:920-499-3937
Practice Address - Fax:920-499-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6198590001332B00000X
WI2517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU40630Medicare UPIN
WIWI1062Medicare PIN
WI6198590001Medicare NSC