Healthcare Provider Details

I. General information

NPI: 1073914420
Provider Name (Legal Business Name): WISCONSIN VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4648 S SCATTERFIELD RD
ANDERSON IN
46013-2900
US

IV. Provider business mailing address

16800 W CLEVELAND AVE
NEW BERLIN WI
53151-3533
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-2005
  • Fax: 262-432-2006
Mailing address:
  • Phone: 262-432-2005
  • Fax: 262-432-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. DARREN THOMAS HORNDASCH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 262-432-2005