Healthcare Provider Details

I. General information

NPI: 1902918493
Provider Name (Legal Business Name): NORTHWOODS FAMILY EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N BRIDGE ST
CHIPPEWA FALLS WI
54729-2404
US

IV. Provider business mailing address

113 N BRIDGE ST
CHIPPEWA FALLS WI
54729-2404
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-9187
  • Fax:
Mailing address:
  • Phone: 715-723-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0246180001
License Number StateWI

VIII. Authorized Official

Name: DR. DENISE GLANTZ ARNESON
Title or Position: PARTNER
Credential: O.D.
Phone: 715-723-9187