| |
325 E. Chicago St., Suite 100, Milwaukee, WI 53202-5836 | |
(414) 727-5888 | |
(414) 727-5889 |
Full Name | |
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Type | Facility |
Speciality | Eyewear Supplier |
Location | 325 E. Chicago St., Milwaukee, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1366680183 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | 2868-035 (Wisconsin) | Primary |
Provider Name | Amy L Jankowski |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1174518161 PECOS PAC ID: 4880647601 Enrollment ID: I20050222000126 |
Provider Name | Amanda L Kopczyk |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1982964730 PECOS PAC ID: 7810143476 Enrollment ID: I20120814000401 |
Mailing Address | Practice Location Address |
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325 E. Chicago St., Suite 100, Milwaukee, WI 53202-5836 Ph: (414) 727-5888 | 325 E. Chicago St., Suite 100, Milwaukee, WI 53202-5836 Ph: (414) 727-5888 |