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General NPI Number Information
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NPI Number | 1538142245
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Entity Type | Organization
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Legal Business Name | EYE CLINIC OF WISCONSIN, S.C.
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 2 E OCALA ST
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City | RHINELANDER
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State | WI
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Zip | 54501-3907
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Country | US
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Telephone | 715-362-2600
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Fax | 715-362-2081
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Provider Business Mailing Address
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Address Line | 800 1ST ST PO BOX 689
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City | WAUSAU
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State | WI
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Zip | 54403-4754
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Country | US
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Telephone | 715-261-8500
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Fax | 715-261-8667
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Authorized Official
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Title or Position | MD OWNER
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Name | DOUGLAS T. EDWARDS
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Credential | MD
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Telephone | 715-261-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | WI
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