# NORTHEAST WISCONSIN RETINA ASSOCIATES SC

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

## Provider details

- **NPI number:** 1437164175
- **Authorized official:** AMY DEBRUIN (BILLING DEPARTMENT MANAGER)
- **Authorized official phone:** (920) 751-8666

## Contact information

- **Practice address:** 442 N WESTHILL BLVD STE A, APPLETON, WI 54914-5830
- **Practice address phone:** (920) 751-8666
- **Practice address fax:** (920) 751-0288
- **Mailing address:** 442 N WESTHILL BLVD STE A, APPLETON, WI 54914-5830
- **Mailing address phone:** (920) 751-8666
- **Mailing address fax:** (920) 751-0288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 08/29/2023