Vita Park Eye Associates, Sc

NPI 1154418051

Information of Vita Park Eye Associates, Sc

The NPI 1154418051 is an Organization type. NPI No 1154418051 belongs to Vita Park Eye Associates, Sc. Vita Park Eye Associates, Sc specializes in Optometrist. is practising at 240 Corporate Drive, Beaver Dam, Wisconsin 53916. You can also contact him via phone number (920) 887-1151.

Practice address located

  • 240 Corporate Drive
  • Beaver Dam, Wisconsin 53916
  • (920) 887-1151
  • (920) 887-1151

Mailling address located

  • 240 Corporate Drive
  • Beaver Dam, Wisconsin 53916
  • (920) 887-1151
  • (920) 887-3353
Vita Park Eye Associates, Sc is PECOS enrolled.
NPI No 1154418051
Primary Taxonomy
Authorized Official
Specialty of the provider
PrimaryTaxonomy CodeClassificationLicense NumberLicense State
No152W00000XOptometristn/an/a
Yes207W00000XOphthalmologyn/an/a
Identifier for this provider
StateIdentifierTypeIssuer
WI000016160Medicare ID-Type Unspecifiedn/a
WI21310700Medicaidn/a
WICP765OtherRAIL ROAD MEDICARE
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