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Organization
EYE PHYSICIAN ASSOCIATES, S.C.
Active
Organization
EYE PHYSICIAN ASSOCIATES, S.C.
Active
Other names
Loomis Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES B YANG MD (MEDICAL DIRECTOR)
(414) 928-2020
Entity
Organization
Contact information
Practice address
4300 WEST LAYTON AVENUE, STE 100, GREENFIELD, WI 53220-5132
(414) 928-2020
(414) 210-3402
Mailing address
4300 W. LAYTON AVE, STE 100, GREENFIELD, WI 53220-4136
(414) 260-0789
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0264580001
DME
WI
05
—
32306500
—
WI
05
—
32735700
—
WI
05
—
34249800
—
WI
05
—
34678800
—
WI
05
—
38616200
—
WI
05
—
38622400
—
WI
Enumeration date
06/05/2023
Last updated
03/19/2024
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