Organization
EYECARE CENTER OF WAUSAU LLC
Active
Other names
Eyecare Center of Wausau
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY LEE LEISCHER OD (OWNER)
(715) 848-2020
Entity
Organization
Contact information
Practice address
611 STEVENS DR, WAUSAU, WI 54401-3006
(715) 848-2020
(715) 845-6669
Mailing address
611 STEVENS DR, WAUSAU, WI 54401-3006
(715) 848-2020
(715) 845-6669
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2687
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000047394
MEDICARE PTAN
WI
Enumeration date
02/11/2009
Last updated
11/27/2023
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