| Lakeshore Vision Centers Ltd | |
|
1217 Ellis St Kewaunee WI 54216 | |
| (920) 388-2020 | |
| (920) 388-3594 |
| Full Name | Lakeshore Vision Centers Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 1217 Ellis St, Kewaunee, Wisconsin |
| Authorized Official Name and Position | Susan A Gorz (CO OWNER VICE PRESIDENT) |
| Authorized Official Contact | 9204872020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Vision Centers Ltd 1217 Ellis St Kewaunee WI 54216 Ph: (920) 388-2020 | Lakeshore Vision Centers Ltd 1217 Ellis St Kewaunee WI 54216 Ph: (920) 388-2020 |
| NPI Number | 1073663704 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 04/22/2009 |
| Medicare PECOS PAC ID | 9133200900 |
|---|---|
| Medicare Enrollment ID | O20100930045774 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073663704 | NPI | - | NPPES |
| 000047383 | Other | WI | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Fmc Kewaunee Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 575 4th St, Kewaunee, WI 54216 Phone: 920-388-4640 |