Healthcare Provider Details

I. General information

NPI: 1043836182
Provider Name (Legal Business Name): INDEPENDENT VISION GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 HEIGHTS DR STE 1A
EAU CLAIRE WI
54701-6146
US

IV. Provider business mailing address

2125 HEIGHTS DR STE 1A
EAU CLAIRE WI
54701-6146
US

V. Phone/Fax

Practice location:
  • Phone: 715-449-8400
  • Fax: 719-449-8400
Mailing address:
  • Phone: 715-449-8400
  • Fax: 715-449-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE HARVEY
Title or Position: CEO
Credential:
Phone: 715-797-8310