Organization
E JOHN ELDRIDGE MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE JOHN ELDRIDGE MD (PRESIDENT)
(262) 652-9500
Entity
Organization
Contact information
Practice address
1400 75TH ST, SUITE 3, KENOSHA, WI 53143
(262) 652-9500
(262) 652-0760
Mailing address
1400 75TH ST, SUITE 3, KENOSHA, WI 53143
(262) 652-9500
(262) 652-0760
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25921
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31384000
—
WI
Enumeration date
09/20/2006
Last updated
08/22/2020
Update your record
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