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General NPI Number Information
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NPI Number | 1427103084
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Entity Type | Organization
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Legal Business Name | SPRING GREEN VISION CENTER, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 150 E JEFFERSON ST
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City | SPRING GREEN
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State | WI
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Zip | 53588-0100
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Country | US
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Telephone | 608-588-2612
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Fax | 608-588-3227
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Provider Business Mailing Address
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Address Line | 150 E JEFFERSON ST PO BOX 100
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City | SPRING GREEN
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State | WI
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Zip | 53588-0100
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Country | US
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Telephone | 608-588-2612
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Fax | 608-588-3227
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Authorized Official
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Title or Position | OPTOMETRIST & OWNER
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Name | DR. JEFFREY L VODAK
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Credential | O.D.
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Telephone | 608-588-2612
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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 | 1843
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License Number State | WI
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