Organization
THE EYE GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DAGENAIS OD (OWNER/OPTOMETRIST)
(262) 542-7113
Entity
Organization
Contact information
Practice address
3228 TURNBERRY OAK DR, SUITE 200, WAUKESHA, WI 53188-3969
(262) 542-7113
(262) 542-9439
Mailing address
3228 TURNBERRY OAK DR, SUITE 200, WAUKESHA, WI 53188-3969
(262) 542-7113
(262) 542-9439
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2704-035
WI
152W00000X
Optometrist
Primary
2760-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE9562
PALMETTO GBA-RAILROAD MEDICARE
WI
Enumeration date
03/29/2006
Last updated
05/16/2023
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