Organization
OPHTHALMIC SURGERY OF WI LTD
Active
Other names
Ophthalmic Surgery of Wisconsin Ltd
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD P CLARKE M.D. (PRESIDENT)
(920) 236-4160
Entity
Organization
Contact information
Practice address
509 S WASHBURN ST, OSHKOSH, WI 54904-7949
(920) 236-4160
(920) 236-4166
Mailing address
PO BOX 308, NEENAH, WI 54957-0308
(920) 236-4162
(920) 236-4166
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32704500
—
WI
01
—
CS8378
RETIRED RAILROAD MEDICARE
WI
Enumeration date
11/27/2006
Last updated
06/24/2019
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