Provider Demographics
NPI:1033414594
Name:ART OF OPTOMETRY LTD
Entity Type:Organization
Organization Name:ART OF OPTOMETRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-284-3111
Mailing Address - Street 1:127 MAIN ST
Mailing Address - Street 2:P.O. BOX 220
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1769
Mailing Address - Country:US
Mailing Address - Phone:715-284-3111
Mailing Address - Fax:800-380-1741
Practice Address - Street 1:127 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-1769
Practice Address - Country:US
Practice Address - Phone:715-284-3111
Practice Address - Fax:800-380-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2876261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6496830001Medicare NSC