BRODHEAD VISION CLINIC INC, Optometrist BRODHEAD, WI

Contact Information

BRODHEAD VISION CLINIC, INC

1005 17TH STREET
BRODHEAD, WI 53520

Phone: 608-897-2128
Fax: 608-897-3937
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Optometrist	152W00000X	41	Optometry

Indicates primary specialty

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NPI Profile & details for BRODHEAD VISION CLINIC INC · (Female)

NPI #	`1164416236`
Status	Active
Credentials
Entity	Individual
Enumeration date	09/06/2005
Last updated	10/08/2014 - About 12 years ago
Sole proprietor ¹	Not specified
Identifiers	WI License # 1483-035 WI Medicaid 38545800 WI Other PHYSICIANS PLUS 1006622 WI Other RAILROAD MEDICARE 410035917 WI Other MERCYCARE PRUDHGEN
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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