Healthcare Provider Details

I. General information

NPI: 1972723716
Provider Name (Legal Business Name): NORTHERN SIGHT VISION CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N. 6TH STREET
TOMAHAWK WI
54487
US

IV. Provider business mailing address

318 N. 6TH STREET,
TOMAHAWK WI
54487
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-3636
  • Fax: 715-453-3011
Mailing address:
  • Phone: 715-453-3636
  • Fax: 715-453-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2911
License Number StateWI

VIII. Authorized Official

Name: DR. JESSICA J STROMBERG
Title or Position: OPTOMETRIST / CO-OWNER
Credential: OD
Phone: 715-453-3636