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Contact Information

BRODHEAD VISION CLINIC, INC
1005 17TH STREET
BRODHEAD, WI53520
 Phone: 608-897-2128
 Fax: 608-897-3937
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for BRODHEAD VISION CLINIC, INC

NPI # 1164416236
LBN Legal business name BRODHEAD VISION CLINIC, INC
Authorized official DOUGLAS KELLEY - (OWNER/OD)
Entity Organization
Organization subpart 1 No
Enumeration date 09/06/2005
Last updated 10/08/2014 - About 12 years ago
Identifiers
WI License # 1483-035
WI Medicaid 38545800
WI Other PHYSICIANS PLUS 1006622
WI Other RAILROAD MEDICARE 410035917
WI Other MERCYCARE PRUDHGEN
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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