Healthcare Provider Details

I. General information

NPI: 1124121918
Provider Name (Legal Business Name): VISIONCARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATSON ST
RIPON WI
54971-1326
US

IV. Provider business mailing address

PO BOX 202
RIPON WI
54971-0202
US

V. Phone/Fax

Practice location:
  • Phone: 920-748-2676
  • Fax: 920-748-5105
Mailing address:
  • Phone: 920-748-2676
  • Fax: 920-748-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. VICTOR H. ROEDER III
Title or Position: VICE PRESIDENT
Credential: O.D.
Phone: 920-748-2676