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General NPI Number Information
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NPI Number | 1255477402
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Entity Type | Organization
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Legal Business Name | ANDERSON VISION CENTER, LTD.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 461 N WASHBURN ST
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City | OSHKOSH
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State | WI
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Zip | 54904-7812
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Country | US
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Telephone | 920-235-8880
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Fax | 920-235-4906
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Provider Business Mailing Address
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Address Line | 461 N WASHBURN ST
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City | OSHKOSH
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State | WI
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Zip | 54904-7812
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Country | US
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Telephone | 920-235-8880
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Fax | 920-235-4906
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Authorized Official
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Title or Position | MANAGER
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Name | ERIN A BREY
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Credential | BBA
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Telephone | 920-235-8880
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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 | WI1919
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License Number State | WI
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