| |
124 Oak Street, Glenwood City, WI 54013 | |
(715) 265-7127 | |
(715) 265-4238 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 124 Oak Street, Glenwood City, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356444798 | NPI | - | NPPES |
38501900 | Medicaid | WI | |
92533SO | Other | MN | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1396 (Wisconsin) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 97, Glenwood City, WI 54013-0097 Ph: (715) 265-7127 | 124 Oak Street, Glenwood City, WI 54013 Ph: (715) 265-7127 |