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General NPI Number Information
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NPI Number | 1740668565
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Entity Type | Organization
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Legal Business Name | EYECARE SERVICES, LLC
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 3400 NORTH 10TH ST #73
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City | MENOMINEE
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State | MI
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Zip | 49858
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Country | US
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Telephone | 920-213-9237
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Fax |
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Provider Business Mailing Address
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Address Line | 9965 HUDSON PLACE, SUITE 660
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 920-213-9237
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TRACY BUEGE
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Credential |
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Telephone | 920-213-9237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 2653
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License Number State | WI
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