Healthcare Provider Details

I. General information

NPI: 1982136248
Provider Name (Legal Business Name): NOR-DOOR ISLAND EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MAIN RD
WASHINGTON ISLAND WI
54246-9004
US

IV. Provider business mailing address

910 MAIN RD
WASHINGTON ISLAND WI
54246-9004
US

V. Phone/Fax

Practice location:
  • Phone: 920-847-3093
  • Fax:
Mailing address:
  • Phone: 920-847-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2505-35
License Number StateWI

VIII. Authorized Official

Name: CAROLINE S REITER
Title or Position: OWNER
Credential: OD
Phone: 920-847-3093