Healthcare Provider Details

I. General information

NPI: 1093725103
Provider Name (Legal Business Name): SPECTACULAR VISIONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S MAIN ST
CLINTONVILLE WI
54929-1631
US

IV. Provider business mailing address

136 S MAIN ST
CLINTONVILLE WI
54929-1631
US

V. Phone/Fax

Practice location:
  • Phone: 715-823-2020
  • Fax: 715-823-7124
Mailing address:
  • Phone: 715-823-2020
  • Fax: 715-823-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ALICE ARNESON
Title or Position: PRESIDENT
Credential:
Phone: 715-823-2020