Healthcare Provider Details

I. General information

NPI: 1902130297
Provider Name (Legal Business Name): AURORA VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N WESTHAVEN DR
OSHKOSH WI
54904-6947
US

IV. Provider business mailing address

700 N WESTHAVEN DR
OSHKOSH WI
54904-6947
US

V. Phone/Fax

Practice location:
  • Phone: 920-456-2000
  • Fax: 920-456-2001
Mailing address:
  • Phone: 920-456-2000
  • Fax: 920-456-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2524
License Number StateWI

VIII. Authorized Official

Name: RENEE RAETHER
Title or Position: CLINIC MANAGER
Credential:
Phone: 920-303-5626