Organization
EYE SURGERY & LASER CENTER OF WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY GUNNELSON RN, CASC (ADMINISTRATOR)
(414) 773-4662
Entity
Organization
Contact information
Practice address
10200 W INNOVATION DR, SUITE 700, MILWAUKEE, WI 53226-4825
(414) 302-9196
(414) 773-4666
Mailing address
10200 W INNOVATION DRIVE, SUITE 700, MILWAUKEE, WI 53226-4825
(414) 302-9196
(414) 773-4668
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41910800
—
WI
Enumeration date
11/29/2005
Last updated
07/21/2022
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