Basic Information
| Provider Information | |||||||||
| NPI: | 1295139129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VESIC | ||||||||
| FirstName: | NEBOJSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 S 76TH ST | ||||||||
| Address2: | |||||||||
| City: | GREENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531291102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144216450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5300 S 76TH ST | ||||||||
| Address2: | |||||||||
| City: | GREENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531291102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144216450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2014 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 336335 | WI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.