Organization
EYE ASSOCIATES OF GREEN BAY, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY JILOT (ADMINISTRATOR)
(920) 965-4800
Entity
Organization
Contact information
Practice address
2020 RIVERSIDE DR STE 201, GREEN BAY, WI 54301-2300
(920) 965-7000
(920) 965-4701
Mailing address
2020 RIVERSIDE DR STE 201, GREEN BAY, WI 54301-2300
(920) 965-7000
(920) 965-4701
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007100
MEDICARE GROUP
WI
01
—
32899700
WMAP GROUP
WI
01
—
4334090001
ADMINASTAR FEDERAL REGION
WI
01
—
CJ2796
MEDICARE RR GROUP
WI
Enumeration date
07/16/2007
Last updated
05/29/2020
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