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General NPI Number Information
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NPI Number | 1093990855
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Entity Type | Organization
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Legal Business Name | BROOKFIELD VISION CENTER, S.C.
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Dates
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Enumeration Date | 12/29/2007
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Last Update Date | 12/29/2007
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Provider Practice Location Address
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Address Line | 19035 W CAPITOL DR SUITE 106
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City | BROOKFIELD
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State | WI
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Zip | 53045-2755
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Country | US
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Telephone | 262-754-4880
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Fax | 262-754-9814
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Provider Business Mailing Address
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Address Line | 19035 W CAPITOL DR SUITE 106
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City | BROOKFIELD
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State | WI
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Zip | 53045-2755
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Country | US
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Telephone | 262-754-4880
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Fax | 262-754-9814
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JASON L VARNER
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Credential | O.D.
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Telephone | 262-754-4880
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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 | WI2821
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License Number State | WI
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