Healthcare Provider Details

I. General information

NPI: 1952354698
Provider Name (Legal Business Name): NORTHERN WATERS OPHTHALMOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 BEASER AVE
ASHLAND WI
54806-3608
US

IV. Provider business mailing address

2111 BEASER AVE
ASHLAND WI
54806-3608
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-0363
  • Fax: 715-682-9638
Mailing address:
  • Phone: 715-682-0363
  • Fax: 715-682-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK W SNEED
Title or Position: PRESIDENT
Credential: MD
Phone: 715-682-0363