Organization Name: | WISCONSIN VISION, INC |
NPI Number: | 1619015716 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARREN THOMAS HORNDASCH (PRESIDENT CEO) |
Mailing Address: | 5620 Crawfordsville Rd Ste A Speedway |
State: | IN US |
Postal Code: | 462243726 |
Phone Number: | 3172435423 |
Fax Number: | 3172435424 |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 05/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |