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Organization

EYE CLINIC OF MANITOWOC, S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DONALD R LEWELLEN M.D. (OPHTHALMOLOGIST/VICE PRESIDENT)
(920) 684-4429
Entity
Organization

Contact information

Practice address
4801 EXPO DR, MANITOWOC, WI 54220-9341
(920) 684-4429
(920) 684-6892
Mailing address
PO BOX 1900, MANITOWOC, WI 54221-1900
(920) 684-4429
(920) 684-6892

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
156FX1800X
Optician
207W00000X
Ophthalmology Physician
Primary
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
21284400
WI
01
CO8042
RAILROAD MEDICARE
WI
Enumeration date
09/15/2005
Last updated
11/19/2009
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