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General NPI Number Information
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NPI Number | 1578866240
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Entity Type | Organization
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Legal Business Name | GLANVILLE EYE CARE LLC
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 201 JUNCTION RD
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City | MADISON
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State | WI
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Zip | 53717-2615
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Country | US
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Telephone | 608-827-0088
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Fax | 608-836-3895
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Provider Business Mailing Address
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Address Line | 201 JUNCTION RD
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City | MADISON
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State | WI
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Zip | 53717-2615
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Country | US
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Telephone | 608-827-0088
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Fax | 608-836-3895
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Authorized Official
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Title or Position | OWNER
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Name | DR. RACHEL KERN GLANVILLE
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Credential | OD
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Telephone | 608-827-0088
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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 | WI 2923
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License Number State | WI
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