| NPI | 1740500180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL ANN ANDERSON Sole Proprietor 715-340-0496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 2651-035) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2010-06-25 |