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General NPI Number Information
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NPI Number | 1447344593
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Entity Type | Organization
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Legal Business Name | WOLF RIVER EYECARE LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 1923 N SHAWANO ST SUITE B
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City | NEW LONDON
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State | WI
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Zip | 54961-7510
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Country | US
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Telephone | 920-982-4561
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Fax | 920-982-9811
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Provider Business Mailing Address
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Address Line | 1923 N SHAWANO ST SUITE B
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City | NEW LONDON
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State | WI
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Zip | 54961-7510
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Country | US
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Telephone | 920-982-4561
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Fax | 920-982-9811
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL K THOMPSON
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Credential | O.D.
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Telephone | 920-982-4561
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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 | 2752-035
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2483-035
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License Number State | WI
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