| |
2900 S Main St, Rice Lake, WI 54868 | |
(715) 234-1511 | |
(715) 434-1513 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 2900 S Main St, Rice Lake, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184727729 | NPI | - | NPPES |
38419400 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (Wisconsin) | Primary |
Mailing Address | Practice Location Address |
---|---|
2900 S Main St, Rice Lake, WI 54868 Ph: (715) 234-1511 | 2900 S Main St, Rice Lake, WI 54868 Ph: (715) 234-1511 |