Provider Demographics
NPI:1437768876
Name:WISCONSIN OPTOMETRIC EYE DOCTOR, INC.
Entity type:Organization
Organization Name:WISCONSIN OPTOMETRIC EYE DOCTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-206-2418
Mailing Address - Street 1:N2577 PLAZA RD # WI-73
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-7706
Mailing Address - Country:US
Mailing Address - Phone:920-787-3837
Mailing Address - Fax:
Practice Address - Street 1:N2577 PLAZA RD # WI-73
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-7706
Practice Address - Country:US
Practice Address - Phone:920-787-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty