MEDICARE: RICE LAKE FAMILY EYECARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2729	WI

General Provider Information

NPI Number	:	1649507062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICE LAKE FAMILY EYECARE, LLC

Provider Business Mailing Address
First Line	:	2900 S MAIN ST
Second Line	:	SUITE NUMBER 15
City	:	RICE LAKE
State	:	WI
Zip	:	54868-2945
Country	:	US
Telephone Number	:	715-234-1511
Fax Number	:	715-234-1511

Provider Business Practice Location Address
First Line	:	2900 S MAIN ST
Second Line	:	SUITE NUMBER 15
City	:	RICE LAKE
State	:	WI
Zip	:	54868-2945
Country	:	US
Telephone Number	:	715-234-1511
Fax Number	:	715-234-1511

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. APRIL DAWN SVOBODA SMITH
Credential	:	O.D.
Telephone Number	:	715-234-1511

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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