Provider Demographics
NPI:1730370826
Name:MORRISON EYE CLINIC, SC
Entity type:Organization
Organization Name:MORRISON EYE CLINIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-728-2667
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2340
Mailing Address - Country:US
Mailing Address - Phone:262-728-2667
Mailing Address - Fax:262-728-3539
Practice Address - Street 1:1221 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2340
Practice Address - Country:US
Practice Address - Phone:262-728-2667
Practice Address - Fax:262-728-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI516110OtherDEAN CARE
WI87442Medicare PIN
WI0339080001Medicare NSC
WI516110OtherDEAN CARE