# OPHTHALMIC SURGERY OF WI LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ophthalmic Surgery of Wisconsin Ltd
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093881609
- **Authorized official:** GERALD P CLARKE M.D. (PRESIDENT)
- **Authorized official phone:** (920) 236-4160

## Contact information

- **Practice address:** 509 S WASHBURN ST, OSHKOSH, WI 54904-7949
- **Practice address phone:** (920) 236-4160
- **Practice address fax:** (920) 236-4166
- **Mailing address:** PO BOX 308, NEENAH, WI 54957-0308
- **Mailing address phone:** (920) 236-4162
- **Mailing address fax:** (920) 236-4166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | WI | Yes |

## Other

- **Enumeration date:** 11/27/2006
- **Last updated:** 06/24/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32704500 | — | WI |
| 01 | — | CS8378 | RETIRED RAILROAD MEDICARE | WI |