# EYE SURGERY & LASER CENTER OF WISCONSIN LLC

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

## Provider details

- **NPI number:** 1568445062
- **Authorized official:** MRS. KELLY GUNNELSON RN, CASC (ADMINISTRATOR)
- **Authorized official phone:** (414) 773-4662

## Contact information

- **Practice address:** 10200 W INNOVATION DR, SUITE 700, MILWAUKEE, WI 53226-4825
- **Practice address phone:** (414) 302-9196
- **Practice address fax:** (414) 773-4666
- **Mailing address:** 10200 W INNOVATION DRIVE, SUITE 700, MILWAUKEE, WI 53226-4825
- **Mailing address phone:** (414) 302-9196
- **Mailing address fax:** (414) 773-4668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | WI | Yes |

## Other

- **Enumeration date:** 11/29/2005
- **Last updated:** 07/21/2022