The Beaver Dam Eye Clinic

LBN: Vita Park Eye Associates, Sc
The Beaver Dam Eye Clinic is an health care organization with primary practice located at 240 Corporate Drive , Beaver Dam WI 53916-3115. The organization recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Allopathic & Osteopathic Physicians / Ophthalmology. Allopathic & Osteopathic Physicians / Ophthalmology is the primary health care specialty. Vita Park Eye Associates, Sc can be contacted via phone (920) 887-1151, or through Castillo, Thomas via phone (920) 887-1151.

Contact Information

Primary practice address
240 Corporate Drive Beaver Dam WI 53916-3115
Phone: (920) 887-1151
Fax: (920) 887-3353
Website:
Map and Directions
Authorized official contact:
Name: Castillo, Thomas Doctor of Osteopathy (DO)
Phone: (920) 887-1151

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X

Profile Details

NPI number 1447276894
LBN Legal business name Vita Park Eye Associates, Sc
DBA Doing business as The Beaver Dam Eye Clinic
Authorized official Castillo, Thomas Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 Yes
Enumeration date Jul 15th, 2006
Last updated Apr 21st, 2021 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1447276894 NPPES
Other 0593830002 DEPMOS SUPPLIER
Other 000016160 DEPMOS SUPPLIER
Other CP765 DEPMOS SUPPLIER
MEDICAID 21310700 DEPMOS SUPPLIER
Other 519075 DEPMOS SUPPLIER

Popular Providers