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General NPI Number Information
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NPI Number | 1346344678
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Entity Type | Organization
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Legal Business Name | SODERBERG EYE CARE CENTER
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 228 PAPERJACK DR
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City | NEW RICHMOND
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State | WI
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Zip | 54017-2430
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Country | US
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Telephone | 715-246-4441
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Fax | 715-246-3250
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Provider Business Mailing Address
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Address Line | 228 PAPERJACK DR
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City | NEW RICHMOND
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State | WI
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Zip | 54017-2430
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Country | US
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Telephone | 715-246-4441
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Fax | 715-246-3250
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS RAYMOND SODERBERG
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Credential | O.D.
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Telephone | 715-246-4441
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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 | 1396
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License Number State | WI
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