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General NPI Number Information
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NPI Number | 1356487995
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Entity Type | Organization
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Legal Business Name | DELAFIELD VISION CENTER LTD
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 3175 GOLD RD
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City | DELAFIELD
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State | WI
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Zip | 53018-2156
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Country | US
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Telephone | 262-646-7400
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Fax | 262-646-7413
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Provider Business Mailing Address
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Address Line | 3175 GOLD RD
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City | DELAFIELD
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State | WI
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Zip | 53018-2156
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Country | US
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Telephone | 262-646-7400
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Fax | 262-646-7413
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIA P JOHNSON
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Credential | OD
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Telephone | 262-646-7400
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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 | 2609035
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License Number State | WI
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