| |
2801 W Kk River Pkwy, Suite 170, Milwaukee, WI 53215-3669 | |
(414) 385-8725 | |
(414) 385-8730 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 2801 W Kk River Pkwy, Milwaukee, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1588963508 | NPI | - | NPPES |
32306500 | Medicaid | WI | |
31912700 | Medicaid | WI | |
38632200 | Medicaid | WI | |
34678800 | Medicaid | WI | |
30934200 | Medicaid | WI | |
32735700 | Medicaid | WI | |
34249800 | Medicaid | WI | |
C017777 | Other | WI | RR MEDICARE |
000073822 | Other | WI | MILWAUKEE PTAN |
1851590343 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
2801 W Kk River Pkwy, Suite 170, Milwaukee, WI 53215-3669 Ph: (414) 385-8725 | 2801 W Kk River Pkwy, Suite 170, Milwaukee, WI 53215-3669 Ph: (414) 385-8725 |