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General NPI Number Information
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NPI Number | 1578609095
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Entity Type | Organization
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Legal Business Name | EYE CARE OPTICAL INC.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 1411 S MAIN ST
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City | WEST BEND
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State | WI
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Zip | 53095-4931
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Country | US
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Telephone | 262-334-2020
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Fax | 262-334-0094
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Provider Business Mailing Address
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Address Line | 1411 S MAIN ST
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City | WEST BEND
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State | WI
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Zip | 53095-4936
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Country | US
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Telephone | 262-334-2020
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Fax | 262-334-0094
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Authorized Official
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Title or Position | OWNEROPTICIAN
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Name | MR. STANLEY C KAMINSKI
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Credential |
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Telephone | 262-334-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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