# EYE CLINIC OF WISCONSIN, S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285617936
- **Authorized official:** DOUGLAS T. EDWARDS MD (MD/OWNER)
- **Authorized official phone:** (715) 261-8540

## Contact information

- **Practice address:** 309 E BROADWAY AVE, MEDFORD, WI 54451-1835
- **Practice address phone:** (715) 748-5775
- **Practice address fax:** (715) 748-0667
- **Mailing address:** 614 1ST ST, WAUSAU, WI 54403-4851
- **Mailing address phone:** (715) 845-8201
- **Mailing address fax:** (715) 848-1722

## Taxonomy

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

## Other

- **Enumeration date:** 11/28/2005
- **Last updated:** 02/17/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32667800 | — | WI |