| |
240 Corporate Drive, Beaver Dam, WI 53916-3115 | |
(920) 887-1151 | |
(920) 887-3353 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 240 Corporate Drive, Beaver Dam, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1447276894 | NPI | - | NPPES |
0593830002 | Other | DEPMOS SUPPLIER | |
000016160 | Other | OFFICE LOCATION | |
CP765 | Other | WI | RAIL ROAD MEDICARE |
21310700 | Medicaid | WI | |
519075 | Other | DEAN CARE HMO LOCATION |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
240 Corporate Dr, Beaver Dam, WI 53916-3115 Ph: (920) 887-1151 | 240 Corporate Drive, Beaver Dam, WI 53916-3115 Ph: (920) 887-1151 |