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General NPI Number Information
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NPI Number | 1194932111
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Entity Type | Organization
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Legal Business Name | MILTON & EDGERTON VISION CENTERS, LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 1110 N MAIN ST
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City | EDGERTON
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State | WI
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Zip | 53534-1328
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Country | US
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Telephone | 608-884-3314
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Fax | 608-884-4923
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Provider Business Mailing Address
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Address Line | 1110 N MAIN ST
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City | EDGERTON
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State | WI
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Zip | 53534-1328
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Country | US
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Telephone | 608-884-3314
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Fax | 608-884-4923
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Authorized Official
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Title or Position | DOCTOR/CO-OWNER
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Name | DR. JAYME NICOLE LONG
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Credential | OD
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Telephone | 608-884-3314
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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 | 1749
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License Number State | WI
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