Provider Demographics
NPI:1144463571
Name:FAMILY EYE CARE OF LAKE GENEVA, S.C.
Entity type:Organization
Organization Name:FAMILY EYE CARE OF LAKE GENEVA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:HEINKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-248-4878
Mailing Address - Street 1:835 GENEVA PKWY N STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-5700
Mailing Address - Country:US
Mailing Address - Phone:262-248-4878
Mailing Address - Fax:262-248-1100
Practice Address - Street 1:835 GENEVA PKWY N STE 3
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-5700
Practice Address - Country:US
Practice Address - Phone:262-248-4878
Practice Address - Fax:262-248-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3133-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty