| |
123 Hospital Dr, Suite 1002, Watertown, WI 53098-3320 | |
(920) 261-8225 | |
(920) 261-5343 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 123 Hospital Dr, Watertown, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1083943138 | NPI | - | NPPES |
100007049 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (Wisconsin) | Secondary |
207W00000X | Ophthalmology | (Wisconsin) | Primary |
Mailing Address | Practice Location Address |
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125 Hospital Dr, Watertown, WI 53098-3303 Ph: (920) 262-4784 | 123 Hospital Dr, Suite 1002, Watertown, WI 53098-3320 Ph: (920) 261-8225 |