Provider Demographics
NPI:1811508773
Name:DEWINTER EYE CARE CENTER, LLC
Entity type:Organization
Organization Name:DEWINTER EYE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEWINTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-679-1420
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-0547
Mailing Address - Country:US
Mailing Address - Phone:262-679-1420
Mailing Address - Fax:
Practice Address - Street 1:S73W16437 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9723
Practice Address - Country:US
Practice Address - Phone:262-679-1420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty