Provider Demographics
NPI:1932565868
Name:AURORA HEALTH CARE VENTURES INC.
Entity Type:Organization
Organization Name:AURORA HEALTH CARE VENTURES INC.
Other - Org Name:AURORA VISION CENTER - PORT WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-3266
Mailing Address - Street 1:1777 W GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2077
Mailing Address - Country:US
Mailing Address - Phone:262-284-3456
Mailing Address - Fax:
Practice Address - Street 1:1777 W GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2077
Practice Address - Country:US
Practice Address - Phone:262-284-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100097969Medicaid