Organization
COMMUNITY EYECARE INC
Active
Other names
Community Eyecare Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES J BURGESS OD (PRESIDENT)
(920) 722-6872
Entity
Organization
Contact information
Practice address
950 W RYAN ST, SUITE A, BRILLION, WI 54110
(920) 756-2020
(920) 756-2000
Mailing address
1255 APPLETON RD, PO BOX 534, MENASHA, WI 54952-1501
(920) 722-6872
(920) 722-6335
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2676
WI
152W00000X
Optometrist
2869
WI
152WC0802X
Corneal and Contact Management Optometrist
2676
WI
152WC0802X
Corneal and Contact Management Optometrist
2869
WI
152WL0500X
Low Vision Rehabilitation Optometrist
2676
WI
152WP0200X
Pediatric Optometrist
2676
WI
152WP0200X
Pediatric Optometrist
2869
WI
152WS0006X
Sports Vision Optometrist
2676
WI
152WS0006X
Sports Vision Optometrist
2869
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38601700
—
WI
Enumeration date
10/02/2007
Last updated
05/15/2008
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