| |
4300 West Layton Avenue, Ste 100, Greenfield, WI 53220-5132 | |
(414) 928-2020 | |
(414) 210-3402 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 4300 West Layton Avenue, Greenfield, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1174217178 | NPI | - | NPPES |
32306500 | Medicaid | WI | |
32735700 | Medicaid | WI | |
0264580001 | Other | WI | DME |
34249800 | Medicaid | WI | |
34678800 | Medicaid | WI | |
38616200 | Medicaid | WI | |
38622400 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
4300 W. Layton Ave, Ste 100, Greenfield, WI 53220-4136 Ph: (414) 260-0789 | 4300 West Layton Avenue, Ste 100, Greenfield, WI 53220-5132 Ph: (414) 928-2020 |