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General NPI Number Information
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NPI Number | 1427245042
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Entity Type | Organization
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Legal Business Name | VICTORIAN EYES
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 1400 UNIVERSITY DR STE 102
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City | MARINETTE
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State | WI
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Zip | 54143-5106
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Country | US
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Telephone | 715-732-2007
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Fax | 715-732-0936
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Provider Business Mailing Address
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Address Line | 1400 UNIVERSITY DR STE 102
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City | MARINETTE
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State | WI
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Zip | 54143-5106
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Country | US
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Telephone | 715-732-2007
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Fax | 715-732-0936
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Authorized Official
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Title or Position | OWNER
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Name | JENETTE WEAVER
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Credential |
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Telephone | 715-732-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | WI
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