| NPI | 1104919869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT D. SULLIVAN President 920-734-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: WI 18799) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2483-035) |
| 152W00000X Optometrist (Licence: WI 2752-035) | |
| 152W00000X Optometrist (Licence: WI 2681-035) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-09-03 |