Healthcare Provider Details

I. General information

NPI: 1083827919
Provider Name (Legal Business Name): DEAN M SPRINGER EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MAPLE ST S
TURTLE LAKE WI
54889-8003
US

IV. Provider business mailing address

PO BOX 47
TURTLE LAKE WI
54889-0047
US

V. Phone/Fax

Practice location:
  • Phone: 715-986-4448
  • Fax: 715-986-4595
Mailing address:
  • Phone: 715-986-4448
  • Fax: 715-986-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2109035
License Number StateWI

VIII. Authorized Official

Name: DR. DEAN M SPRINGER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 715-986-4448