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General NPI Number Information
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NPI Number | 1063616571
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Entity Type | Organization
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Legal Business Name | SIREN FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 24082 STATE ROAD 35
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City | SIREN
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State | WI
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Zip | 54872
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Country | US
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Telephone | 715-349-2733
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Fax | 715-349-2744
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Provider Business Mailing Address
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Address Line | P.O. BOX 290 24082 STATE ROAD 35
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City | SIREN
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State | WI
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Zip | 54872-0290
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Country | US
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Telephone | 715-349-2733
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Fax | 715-349-2744
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRIAN DARRELL SMITH
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Credential | O.D.
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Telephone | 715-349-2733
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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 | 2728
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License Number State | WI
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