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General NPI Number Information
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NPI Number | 1306047618
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Entity Type | Organization
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Legal Business Name | HERMAN ADVANCED FAMILY EYECARE LLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 11/14/2010
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Provider Practice Location Address
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Address Line | 1402 MAIN ST
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City | BLOOMER
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State | WI
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Zip | 54724-1637
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Country | US
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Telephone | 715-568-1373
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 MAIN ST
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City | BLOOMER
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State | WI
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Zip | 54724-1637
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Country | US
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Telephone | 715-568-1373
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAREN L HERMAN
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Credential | OD
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Telephone | 715-568-1373
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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 | 3016-35
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License Number State | WI
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