Provider Demographics
NPI:1679749170
Name:NORTH AVENUE VISION CENTER
Entity type:Organization
Organization Name:NORTH AVENUE VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEFRIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-342-3622
Mailing Address - Street 1:2230 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1134
Mailing Address - Country:US
Mailing Address - Phone:414-342-3622
Mailing Address - Fax:414-342-2680
Practice Address - Street 1:2230 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1134
Practice Address - Country:US
Practice Address - Phone:414-342-3622
Practice Address - Fax:414-342-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1088152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38405200Medicaid
WI38405200Medicaid