Healthcare Provider Details

I. General information

NPI: 1073665527
Provider Name (Legal Business Name): OPTIVISION EYE CARE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S NICOLET RD
APPLETON WI
54914-3938
US

IV. Provider business mailing address

223 S NICOLET RD
APPLETON WI
54914-3938
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-5888
  • Fax: 920-733-5151
Mailing address:
  • Phone: 920-733-5888
  • Fax: 920-733-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CARRIE BARFELS
Title or Position: BILLER
Credential:
Phone: 920-364-9213