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General NPI Number Information
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NPI Number | 1174751127
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Entity Type | Organization
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Legal Business Name | R&G VISION, LLC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 1609 CENTER AVE
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City | JANESVILLE
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State | WI
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Zip | 53546-2819
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Country | US
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Telephone | 608-758-3466
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 CENTER AVE
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City | JANESVILLE
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State | WI
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Zip | 53546-2819
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Country | US
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Telephone | 608-758-3466
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Fax |
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Authorized Official
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Title or Position | OPTICIAN/CO OWNER
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Name | GENNI A MAHONEY
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Credential |
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Telephone | 608-758-3466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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