| Organization Name: | GREAT LAKES FAMILY VISION SC |
| NPI Number: | 1437485125 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STUART WADE NATALE (OWNER/ OPTOMETRIST) |
| Mailing Address: | 289 E Green Bay Ave Saukville |
| State: | WI US |
| Postal Code: | 530802006 |
| Phone Number: | 2622682007 |
| Fax Number: | 2622688257 |
| NPI Enumeration Date: | 10/30/2009 |
| NPI Last Update Date: | 12/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | 2716035 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |