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General NPI Number Information
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NPI Number | 1366654980
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Entity Type | Organization
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Legal Business Name | ST. CROIX TRIBAL COUNCIL
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 4404 STATE ROAD 70
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City | WEBSTER
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State | WI
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Zip | 54893-9251
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Country | US
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Telephone | 715-349-8554
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Fax | 715-349-2559
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Provider Business Mailing Address
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Address Line | 4404 STATE ROAD 70
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City | WEBSTER
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State | WI
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Zip | 54893-9251
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Country | US
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Telephone | 715-349-8554
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Fax | 715-349-2559
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Authorized Official
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Title or Position | HEALTH DIRECTOR
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Name | AMBER HEINZ
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Credential |
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Telephone | 715-349-8554
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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 | 2728-035
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License Number State | WI
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