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General NPI Number Information
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NPI Number | 1831467703
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Entity Type | Organization
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Legal Business Name | EYE SEE, LLC
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 2440 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4711
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Country | US
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Telephone | 920-405-9165
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Fax | 920-405-9296
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Provider Business Mailing Address
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Address Line | PO BOX 5404
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City | DE PERE
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State | WI
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Zip | 54115-5404
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Country | US
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Telephone | 920-405-9165
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Fax | 920-405-9296
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Authorized Official
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Title or Position | OPTOMETRIST/MEMBER OF EYE SEE, LLC
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Name | DR. LAURIE J LARSON
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Credential | O.D.
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Telephone | 920-405-9165
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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 | 2929-035
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License Number State | WI
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