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Organization
EYE CENTERS OF RACINE AND KENOSHA LTD
Active
Organization
EYE CENTERS OF RACINE AND KENOSHA LTD
Active
Other names
Eye Center of Racine LTD, The Eye Centers of Racine and Kenosha
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GOTTFREDSEN (PRACTICE ADMINISTRATOR)
(262) 898-5673
Entity
Organization
Contact information
Practice address
13200 GLOBE DR STE 216, MT PLEASANT, WI 53177-1605
(262) 637-0500
(262) 635-8027
Mailing address
3805B SPRING ST, SUITE 140, RACINE, WI 53405-1641
(262) 637-0500
(262) 635-8027
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0631860001
NGS ADMINISTAR
WI
05
—
100202317
—
WI
05
—
38713800
—
WI
Enumeration date
07/18/2006
Last updated
04/21/2025
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