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General NPI Number Information
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NPI Number | 1043665482
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Entity Type | Organization
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Legal Business Name | STOUGHTON EYE CARE & EYEWEAR LLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 2300 US HIGHWAY 51 AND 138 SUITE E
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City | STOUGHTON
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State | WI
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Zip | 53589-2080
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Country | US
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Telephone | 608-205-2293
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Fax | 608-205-6813
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Provider Business Mailing Address
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Address Line | 2300 US HIGHWAY 51 AND 138 SUITE E
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City | STOUGHTON
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State | WI
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Zip | 53589-2080
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Country | US
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Telephone | 608-205-2293
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Fax | 608-205-6813
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ANDREW JAMES LINDELL
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Credential | O.D.
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Telephone | 231-920-5729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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