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General NPI Number Information
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NPI Number | 1285343301
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Entity Type | Organization
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Legal Business Name | MIDLINE VISION GROUP, LLC
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 6231 MCKEE RD STE C
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City | FITCHBURG
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State | WI
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Zip | 53719-5177
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Country | US
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Telephone | 608-273-2020
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Fax | 608-234-4330
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Provider Business Mailing Address
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Address Line | 408 N 3RD ST STE 402
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City | WAUSAU
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State | WI
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Zip | 54403-5455
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Country | US
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Telephone | 715-298-3486
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Fax | 152-983-4867
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Authorized Official
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Title or Position | MANAGER CBO
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Name | MICHELLE HUBER
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Credential |
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Telephone | 715-298-3486
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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 |
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License Number State |
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