| NPI | 1659332823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DAGENAIS Owner/Optometrist 262-542-7113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 2760-035) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2704-035) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2023-05-16 |