Healthcare Provider Details

I. General information

NPI: 1558547810
Provider Name (Legal Business Name): RIVER VALLEY VISION, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 STEIN BLVD
EAU CLAIRE WI
54701
US

IV. Provider business mailing address

2600 STEIN BLVD
EAU CLAIRE WI
54701
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-4946
  • Fax: 715-832-0699
Mailing address:
  • Phone: 715-832-4946
  • Fax: 715-832-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1355035
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3035-035
License Number StateWI

VIII. Authorized Official

Name: REBECCA KABAT
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 715-832-4946