# EYE ASSOCIATES OF GREEN BAY, SC

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

## Provider details

- **NPI number:** 1699974980
- **Authorized official:** SALLY JILOT (ADMINISTRATOR)
- **Authorized official phone:** (920) 965-4800

## Contact information

- **Practice address:** 2020 RIVERSIDE DR STE 201, GREEN BAY, WI 54301-2300
- **Practice address phone:** (920) 965-7000
- **Practice address fax:** (920) 965-4701
- **Mailing address:** 2020 RIVERSIDE DR STE 201, GREEN BAY, WI 54301-2300
- **Mailing address phone:** (920) 965-7000
- **Mailing address fax:** (920) 965-4701

## Taxonomy

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

## Other

- **Enumeration date:** 07/16/2007
- **Last updated:** 05/29/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000007100 | MEDICARE GROUP | WI |
| 01 | — | 32899700 | WMAP GROUP | WI |
| 01 | — | 4334090001 | ADMINASTAR FEDERAL REGION | WI |
| 01 | — | CJ2796 | MEDICARE RR GROUP | WI |