Provider Demographics
NPI:1932363371
Name:EYE CARE OPTICAL
Entity Type:Organization
Organization Name:EYE CARE OPTICAL
Other - Org Name:SPECS APPEAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-962-2020
Mailing Address - Street 1:420 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5047
Mailing Address - Country:US
Mailing Address - Phone:414-962-2020
Mailing Address - Fax:
Practice Address - Street 1:420 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5047
Practice Address - Country:US
Practice Address - Phone:414-962-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0262070001Medicare NSC