Organization
ADVANCED EYECARE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY M ANHALT (BILLING SPECIALIST)
(920) 893-8474
Entity
Organization
Contact information
Practice address
300 E MILL ST, PLYMOUTH, WI 53073-1804
(920) 893-8474
(920) 893-8814
Mailing address
300 E MILL ST, PLYMOUTH, WI 53073-1804
(920) 893-8474
(920) 893-8814
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2461
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38591200
—
WI
Enumeration date
09/16/2006
Last updated
04/27/2015
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