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General NPI Number Information
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NPI Number | 1538589304
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Entity Type | Organization
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Legal Business Name | ALLINFAVOR, INC.
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 2721 S GREEN BAY RD
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City | RACINE
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State | WI
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Zip | 53406-4949
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Country | US
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Telephone | 262-554-5991
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Fax | 262-554-1293
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Provider Business Mailing Address
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Address Line | 316 MAIN ST
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City | RACINE
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State | WI
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Zip | 53403-1029
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Country | US
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Telephone | 262-554-5991
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Fax | 262-554-1293
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARA K. NICHOLSON
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Credential | OD
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Telephone | 262-989-9629
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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 | 2990-35
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License Number State | WI
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