| NPI | 1558583930 |
|---|---|
| Doing Business As | VISION SOURCE SHAWANO |
| Entity Type | Organization |
| Authorized Contact | NELSON H. HASSELL President 715-524-4997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 2422) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-12-02 |