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General NPI Number Information
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NPI Number | 1447377148
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Entity Type | Organization
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Legal Business Name | EYE & VISION CLINICS, S.C.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 140 SCHOOL CREEK TRL
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City | LUXEMBURG
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State | WI
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Zip | 54217-1095
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Country | US
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Telephone | 920-845-5555
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Fax | 920-845-5219
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Provider Business Mailing Address
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Address Line | 140 SCHOOL CREEK TRL
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City | LUXEMBURG
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State | WI
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Zip | 54217-1095
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Country | US
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Telephone | 920-845-5555
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Fax | 920-845-5219
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | JENNIFER POTTS
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Credential |
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Telephone | 920-845-5555
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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 | 1428
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License Number State | WI
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