Provider Demographics
NPI:1548445737
Name:PENINSULA VISION CARE LLC
Entity type:Organization
Organization Name:PENINSULA VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FILAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-743-5053
Mailing Address - Street 1:1426 EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1240
Mailing Address - Country:US
Mailing Address - Phone:920-743-5053
Mailing Address - Fax:920-743-8802
Practice Address - Street 1:1426 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1240
Practice Address - Country:US
Practice Address - Phone:920-743-5053
Practice Address - Fax:920-743-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38624800Medicaid
WI5313370001Medicare NSC