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General NPI Number Information
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NPI Number | 1104408590
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Entity Type | Organization
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Legal Business Name | FITCHBURG FAMILY EYE CARE LLC
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Dates
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Enumeration Date | 04/25/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 6635 MCKEE RD
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City | MADISON
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State | WI
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Zip | 53719-5023
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Country | US
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Telephone | 608-299-9777
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Fax | 608-299-9775
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Provider Business Mailing Address
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Address Line | 2797 LEO MARY ST
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City | FITCHBURG
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State | WI
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Zip | 53711-9305
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Country | US
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Telephone | 502-235-8472
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JINGPING XU
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Credential | OD
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Telephone | 502-235-8472
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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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