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Organization
EYE CLINIC OF MANITOWOC, S.C.
Active
Organization
EYE CLINIC OF MANITOWOC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD R LEWELLEN M.D. (OPHTHALMOLOGIST/VICE PRESIDENT)
(920) 684-4429
Entity
Organization
Contact information
Practice address
4801 EXPO DR, MANITOWOC, WI 54220-9341
(920) 684-4429
(920) 684-6892
Mailing address
PO BOX 1900, MANITOWOC, WI 54221-1900
(920) 684-4429
(920) 684-6892
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
156FX1800X
Optician
—
NULL
156FX1800X
Optician
—
—
207W00000X
Ophthalmology Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21284400
—
WI
01
—
CO8042
RAILROAD MEDICARE
WI
Enumeration date
09/15/2005
Last updated
11/19/2009
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