| NPI | 1861989501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA TOELLNER Access Manager 920-735-9914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 2422-35) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: WI 26341-20) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2023-09-08 |