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General NPI Number Information
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NPI Number | 1932745163
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Entity Type | Organization
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Legal Business Name | MAUSTON FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 201 E STATE ST
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City | MAUSTON
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State | WI
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Zip | 53948-1346
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Country | US
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Telephone | 608-847-6264
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E STATE ST
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City | MAUSTON
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State | WI
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Zip | 53948-1346
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Country | US
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Telephone | 608-847-6264
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Fax | 608-847-7279
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE FERCHOFF RENNER
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Credential |
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Telephone | 608-847-6264
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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 |
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License Number State |
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