Healthcare Provider Details

I. General information

NPI: 1508891706
Provider Name (Legal Business Name): CHIPPEWA VALLEY EYE CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CTH I
CHIPPEWA FALLS WI
54729
US

IV. Provider business mailing address

2525 CTH I
CHIPPEWA FALLS WI
54729
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-6520
  • Fax: 715-723-1092
Mailing address:
  • Phone: 715-723-6520
  • Fax: 715-723-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY F BROWN
Title or Position: V PRES
Credential: MD
Phone: 715-723-6520