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General NPI Number Information
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NPI Number | 1578027884
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Entity Type | Organization
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Legal Business Name | BAYSHORE VISION, LLC
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 420 W SILVER SPRING DR
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City | GLENDALE
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State | WI
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Zip | 53217-5047
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Country | US
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Telephone | 414-962-2020
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Fax |
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Provider Business Mailing Address
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Address Line | N72W8057 HARVEST LN
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City | CEDARBURG
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State | WI
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Zip | 53012-1750
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Country | US
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Telephone | 414-659-2015
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Fax |
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Authorized Official
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Title or Position | OWNER/OD
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Name | DR. JENNIFER FRIEHE
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Credential | OD
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Telephone | 414-659-2015
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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 |
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License Number State |
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