MEDICARE: HERSLOF'S, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1124157607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERSLOF'S, INC

Provider Business Mailing Address
First Line	:	12000 W CARMEN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-2116
Country	:	US
Telephone Number	:	414-462-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	11307 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3411
Country	:	US
Telephone Number	:	262-241-1919
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	VICKI DICKMAN
Credential	:
Telephone Number	:	414-462-1300

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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