Provider Demographics
NPI:1053359992
Name:EYEWEAR SPECIALISTS, INC
Entity type:Organization
Organization Name:EYEWEAR SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAEVEN-COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-734-8714
Mailing Address - Street 1:1301 E NORTHLAND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8426
Mailing Address - Country:US
Mailing Address - Phone:920-734-8714
Mailing Address - Fax:920-734-8785
Practice Address - Street 1:1301 E NORTHLAND AVE
Practice Address - Street 2:STE A
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8426
Practice Address - Country:US
Practice Address - Phone:920-734-8714
Practice Address - Fax:920-734-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1308910001Medicare NSC