Organization
EYE PHYSICIAN ASSOCIATES, S.C.
Active
Parent organization
EYE PHYSICIAN ASSOCIATES, S.C.
Other names
Eye Physician Associates, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
EYE PHYSICIAN ASSOCIATES, S.C.
Authorized official
DR. MICHAEL RISSELL M.D. (PRESIDENT)
(414) 385-8725
Entity
Organization
Contact information
Practice address
2801 W KK RIVER PKWY, SUITE 170, MILWAUKEE, WI 53215-3669
(414) 385-8725
(414) 385-8730
Mailing address
2801 W KK RIVER PKWY, SUITE 170, MILWAUKEE, WI 53215-3669
(414) 385-8725
(414) 385-8730
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000073822
MILWAUKEE PTAN
WI
05
—
1851590343
—
WI
05
—
30934200
—
WI
05
—
31912700
—
WI
05
—
32306500
—
WI
05
—
32735700
—
WI
05
—
34249800
—
WI
05
—
34678800
—
WI
05
—
38632200
—
WI
01
—
C017777
RR MEDICARE
WI
Enumeration date
03/16/2011
Last updated
11/16/2011
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