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General NPI Number Information
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NPI Number | 1548413107
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Entity Type | Organization
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Legal Business Name | FAMILY VISION CENTER OF LA CROSSE
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1825 N SUPERIOR AVE
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City | TOMAH
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State | WI
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Zip | 54660-1683
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Country | US
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Telephone | 608-372-4664
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Fax | 608-372-3021
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Provider Business Mailing Address
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Address Line | 1825 N SUPERIOR AVE
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City | TOMAH
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State | WI
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Zip | 54660-1683
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Country | US
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Telephone | 608-372-4664
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Fax | 608-372-3021
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | ANN M WONDERLING
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Credential | O.D.
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Telephone | 608-788-4300
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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 | 1466
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2949
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License Number State | WI
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