| |
912 Hwy 136 Ste 103, Baraboo, WI 53913-8501 | |
(000) 000-0000 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 912 Hwy 136 Ste 103, Baraboo, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1760175152 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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Po Box 19060, Green Bay, WI 54307-9060 Ph: (920) 429-7285 | 912 Hwy 136 Ste 103, Baraboo, WI 53913-8501 Ph: (000) 000-0000 |