# EYE CENTERS OF RACINE AND KENOSHA LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eye Center of Racine LTD, The Eye Centers of Racine and Kenosha
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710905781
- **Authorized official:** MELISSA GOTTFREDSEN (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (262) 898-5673

## Contact information

- **Practice address:** 13200 GLOBE DR STE 216, MT PLEASANT, WI 53177-1605
- **Practice address phone:** (262) 637-0500
- **Practice address fax:** (262) 635-8027
- **Mailing address:** 3805B SPRING ST, SUITE 140, RACINE, WI 53405-1641
- **Mailing address phone:** (262) 637-0500
- **Mailing address fax:** (262) 635-8027

## Taxonomy

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

## Other

- **Enumeration date:** 07/18/2006
- **Last updated:** 04/21/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0631860001 | NGS ADMINISTAR | WI |
| 05 | — | 100202317 | — | WI |
| 05 | — | 38713800 | — | WI |