Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with SouthEast Eye, S.C. before sending sensitive documents. FaxFlow is not affiliated with this organization.
SouthEast Eye, S.C. fax number
(262) 654-4365
ophthalmology / eye care
Used for: Medical records release / authorization for disclosure of health information
Fax destination details
- Department
- ophthalmology / eye care
- Purpose
- Medical records release / authorization for disclosure of health information
- Form
- Authorization for Disclosure of Health Information — Authorization for Disclosure of Health Information
- Address
- 6125 Green Bay Rd, Suite 800, Kenosha, WI 53142
- Voice phone
- (262) 654-0726
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill patient name, address and DOB; indicate records to be released; specify recipient (SouthEast Eye, S.C. / Raffi Karapetian, D.O., Matthew Littel, O.D.); sign and date; return to the office.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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