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General NPI Number Information
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NPI Number | 1780198515
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Entity Type | Organization
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Legal Business Name | OPTICAL FASHIONS LTD
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 814 S MAIN ST STE A
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City | HOLMEN
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State | WI
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Zip | 54636-9632
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Country | US
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Telephone | 608-782-7127
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Fax | 608-399-3097
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Provider Business Mailing Address
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Address Line | 2104 STATE ROAD 16
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City | LA CROSSE
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State | WI
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Zip | 54601-3046
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Country | US
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Telephone | 608-782-7127
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Fax | 608-782-7124
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | SUZANNE M EKHOFF
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Credential |
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Telephone | 608-782-7127
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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 | 3116
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3129
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3359
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2705
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License Number State | WI
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