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General NPI Number Information
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NPI Number | 1760877575
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Entity Type | Organization
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Legal Business Name | MERGENTHALER EYE CARE, LLC
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 3649 S HASTINGS WAY TARGET OPTICAL #4150
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City | EAU CLAIRE
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State | WI
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Zip | 54701-8182
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Country | US
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Telephone | 715-838-0462
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Fax |
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Provider Business Mailing Address
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Address Line | 249 E LARKSPUR LN
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City | ONALASKA
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State | WI
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Zip | 54650-8307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MATHEW BRYAN MERGENTHALER
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Credential | O.D.
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Telephone | 608-790-5851
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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 | 3359-35
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License Number State | WI
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