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Organization
OPHTHALMIC SURGERY OF WI LTD
Active
Organization
OPHTHALMIC SURGERY OF WI LTD
Active
Other names
Ophthalmic Surgery of Wisconsin Ltd
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD P CLARKE M.D. (PRESIDENT)
(920) 236-4160
Entity
Organization
Contact information
Practice address
509 S WASHBURN ST, OSHKOSH, WI 54904-7949
(920) 236-4160
(920) 236-4166
Mailing address
PO BOX 308, NEENAH, WI 54957-0308
(920) 236-4162
(920) 236-4166
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32704500
—
WI
01
—
CS8378
RETIRED RAILROAD MEDICARE
WI
Enumeration date
11/27/2006
Last updated
06/24/2019
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