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General NPI Number Information
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NPI Number | 1467625988
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Entity Type | Organization
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Legal Business Name | W E OPTICIANS OF KENOSHA LTD
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 708 55TH ST
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City | KENOSHA
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State | WI
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Zip | 53140-3732
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Country | US
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Telephone | 262-656-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 708 55TH ST
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City | KENOSHA
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State | WI
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Zip | 53140-3732
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Country | US
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Telephone | 262-656-0101
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES J. WHITE
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Credential | CERTIFIED OPTICIAN
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Telephone | 262-656-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | NZ038
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License Number State | WI
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