# EYE CLINIC OF MANITOWOC, S.C.

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

## Provider details

- **NPI number:** 1437144417
- **Authorized official:** DR. DONALD R LEWELLEN M.D. (OPHTHALMOLOGIST/VICE PRESIDENT)
- **Authorized official phone:** (920) 684-4429

## Contact information

- **Practice address:** 4801 EXPO DR, MANITOWOC, WI 54220-9341
- **Practice address phone:** (920) 684-4429
- **Practice address fax:** (920) 684-6892
- **Mailing address:** PO BOX 1900, MANITOWOC, WI 54221-1900
- **Mailing address phone:** (920) 684-4429
- **Mailing address fax:** (920) 684-6892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 156FX1800X | Optician | — | NULL | — |
| 156FX1800X | Optician | — | — | — |
| 207W00000X | Ophthalmology Physician | — | WI | Yes |

## Other

- **Enumeration date:** 09/15/2005
- **Last updated:** 11/19/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 21284400 | — | WI |
| 01 | — | CO8042 | RAILROAD MEDICARE | WI |