Healthcare Provider Details

I. General information

NPI: 1760505515
Provider Name (Legal Business Name): DEAN RETAIL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TOWER DR SUITE 200
SUN PRAIRIE WI
53590-1239
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 608-825-3500
  • Fax: 608-825-3794
Mailing address:
  • Phone: 608-294-6218
  • Fax: 608-250-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateWI

VIII. Authorized Official

Name: AMY J. GRINNELL
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 608-260-3586