# BAYCARE CLINIC, LLP

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

## Provider details

- **NPI number:** 1659645380
- **Authorized official:** TAYLOR KONKLE (PAYOR ENROLLMENT)
- **Authorized official phone:** (920) 301-1327

## Contact information

- **Practice address:** 30 N 18TH AVE, STURGEON BAY, WI 54235-3207
- **Practice address phone:** (920) 743-9532
- **Practice address fax:** (920) 743-9538
- **Mailing address:** PO BOX 28900, GREEN BAY, WI 54324-0900
- **Mailing address phone:** (920) 490-9046

## Taxonomy

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

## Other

- **Enumeration date:** 02/27/2012
- **Last updated:** 08/27/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1588609648 | — | WI |