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General NPI Number Information
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NPI Number | 1053084087
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Entity Type | Organization
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Legal Business Name | FAMILY VISION & CONTACT LENS CENTERS, S.C.
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 309 MCHENRY ST
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City | BURLINGTON
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State | WI
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Zip | 53105-2123
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Country | US
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Telephone | 262-763-0117
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Fax | 262-763-0119
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Provider Business Mailing Address
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Address Line | PO BOX 630
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City | BURLINGTON
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State | WI
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Zip | 53105-0630
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Country | US
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Telephone | 262-763-0117
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Fax | 262-763-0119
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MICHELLE SCHMALFELDT
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Credential |
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Telephone | 262-763-0117
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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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