| |
617 S Pine St, Grantsburg, WI 54840-7935 | |
(715) 463-2370 | |
(608) 571-0088 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 617 S Pine St, Grantsburg, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1174653133 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2608-035 (Wisconsin) | Primary |
152W00000X | Optometrist | 2589-035 (Wisconsin) | Secondary |
Mailing Address | Practice Location Address |
---|---|
Po Box 767, Saint Croix Falls, WI 54024-0767 Ph: (715) 483-3259 | 617 S Pine St, Grantsburg, WI 54840-7935 Ph: (715) 463-2370 |
Bruce E Benedict, O.D. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 617 S Pine St, Grantsburg, WI 54840 Phone: 715-463-2459 |