Healthcare Provider Details

I. General information

NPI: 1578130530
Provider Name (Legal Business Name): CUDAMCCARRON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E CHERYL PKWY STE 103
FITCHBURG WI
53711-5336
US

IV. Provider business mailing address

5500 E CHERYL PKWY STE 103
FITCHBURG WI
53711-5336
US

V. Phone/Fax

Practice location:
  • Phone: 608-273-3937
  • Fax: 608-273-3938
Mailing address:
  • Phone: 608-273-3937
  • Fax: 608-273-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LISA CUDA MCCARRON
Title or Position: OWNER/OPTICIAN
Credential:
Phone: 608-273-3937