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General NPI Number Information
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NPI Number | 1255477386
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Entity Type | Organization
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Legal Business Name | FORESIGHT OPTICAL INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7532 PERSHING BLVD
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City | KENOSHA
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State | WI
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Zip | 53142-4316
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Country | US
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Telephone | 262-694-3400
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Fax | 262-694-9456
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Provider Business Mailing Address
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Address Line | PO BOX 1298 N91 W20810 HILLVIEW DR.
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City | MENOMONEE FALLS
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State | WI
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Zip | 53052-1298
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Country | US
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Telephone | 414-915-3526
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-OPTICIAN
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Name | MR. DONALD JOSEPH GALLE
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Credential |
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Telephone | 262-694-2400
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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 | LICENSE NOT REQUIRED
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License Number State | WI
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