Healthcare Provider Details

I. General information

NPI: 1669585352
Provider Name (Legal Business Name): ST CROIX FALLS EYE ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 OAK ST
FREDERIC WI
54837-9547
US

IV. Provider business mailing address

PO BOX 767
SAINT CROIX FALLS WI
54024-0767
US

V. Phone/Fax

Practice location:
  • Phone: 715-327-8239
  • Fax: 608-571-0088
Mailing address:
  • Phone: 715-483-3259
  • Fax: 608-571-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LAWRENCE S TRAN
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 715-483-3259