Healthcare Provider Details

I. General information

NPI: 1033414594
Provider Name (Legal Business Name): ART OF OPTOMETRY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MAIN ST
BLACK RIVER FALLS WI
54615-1769
US

IV. Provider business mailing address

127 MAIN ST P.O. BOX 220
BLACK RIVER FALLS WI
54615-1769
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-3111
  • Fax: 800-380-1741
Mailing address:
  • Phone: 715-284-3111
  • Fax: 800-380-1741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2876
License Number StateWI

VIII. Authorized Official

Name: DR. MARK ALLEN HANSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 715-284-3111