| |
434 Gammon Pl, Madison, WI 53719-1090 | |
(608) 237-3976 | |
(561) 828-8367 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 434 Gammon Pl, Madison, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1376858308 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 316335 (Wisconsin) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
1615 S Congress Ave Ste 105, Delray Beach, FL 33445-6326 Ph: (561) 275-2020 | 434 Gammon Pl, Madison, WI 53719-1090 Ph: (608) 237-3976 |