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General NPI Number Information
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NPI Number | 1093500845
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Entity Type | Organization
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Legal Business Name | SUGAR RIVER EYE CARE, LLC
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 881 W VERONA AVE STE C
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City | VERONA
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State | WI
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Zip | 53593-1484
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Country | US
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Telephone | 608-502-0919
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Fax | 608-502-0918
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Provider Business Mailing Address
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Address Line | 542 ECHO VALLEY RD
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City | BROOKLYN
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State | WI
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Zip | 53521-9448
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | KRISTIN MCARDLE
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Credential | OD
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Telephone | 608-214-8090
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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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