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General NPI Number Information
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NPI Number | 1871667220
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Entity Type | Organization
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Legal Business Name | CLEAR VIEW OPTICAL, S.C.
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Dates
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Enumeration Date | 11/19/2006
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 1236 GREEN BAY RD
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City | STURGEON BAY
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State | WI
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Zip | 54235-3819
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Country | US
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Telephone | 920-743-8884
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Fax | 920-743-2519
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Provider Business Mailing Address
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Address Line | 1236 GREEN BAY RD
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City | STURGEON BAY
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State | WI
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Zip | 54235-3819
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Country | US
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Telephone | 920-743-8884
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Fax | 920-743-2519
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE MARIE HARPER
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Credential | O.D.
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Telephone | 920-743-8884
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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 | 582971
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License Number State | WI
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