| |
12000 W Carmen Ave, Milwaukee, WI 53225 | |
(414) 462-1300 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Technician/technologist - Optician |
Location | 12000 W Carmen Ave, Milwaukee, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720057482 | NPI | - | NPPES |
38432000 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
156FX1800X | Technician/technologist - Optician | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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12000 W Carmen Ave, Milwaukee, WI 53225-2116 Ph: (414) 462-1300 | 12000 W Carmen Ave, Milwaukee, WI 53225 Ph: (414) 462-1300 |