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General NPI Number Information
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NPI Number | 1134272388
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Entity Type | Organization
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Legal Business Name | REVERIE OPTIQUE
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 2205 N CALHOUN RD STE 16
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City | BROOKFIELD
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State | WI
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Zip | 53005-5062
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Country | US
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Telephone | 262-786-4144
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Fax | 262-786-4729
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Provider Business Mailing Address
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Address Line | 2205 N CALHOUN RD STE 16
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City | BROOKFIELD
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State | WI
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Zip | 53005-5062
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Country | US
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Telephone | 262-786-4144
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Fax | 262-786-4729
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH L BARON
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Credential | O.D.
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Telephone | 262-786-4144
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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 | 2942
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License Number State | WI
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