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General NPI Number Information
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NPI Number | 1891826566
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Entity Type | Organization
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Legal Business Name | OREGON FAMILY EYE CARE, LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 PLEASANT OAK DR SUITE D
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City | OREGON
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State | WI
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Zip | 53575-3648
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Country | US
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Telephone | 608-835-6658
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Fax |
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Provider Business Mailing Address
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Address Line | 600 PLEASANT OAK DR SUITE D
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City | OREGON
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State | WI
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Zip | 53575-3648
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Country | US
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Telephone | 608-835-6658
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. KRISTOPHER LEE GLANVILLE
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Credential | O.D.
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Telephone | 608-835-6658
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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 | 2924
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License Number State | WI
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