Provider Demographics
NPI:1043317266
Name:REZIN OPTICAL LLC
Entity Type:Organization
Organization Name:REZIN OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:REZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-536-4292
Mailing Address - Street 1:728 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2419
Mailing Address - Country:US
Mailing Address - Phone:715-536-4292
Mailing Address - Fax:715-536-4747
Practice Address - Street 1:728 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2419
Practice Address - Country:US
Practice Address - Phone:715-536-4292
Practice Address - Fax:715-536-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1542-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38507400Medicaid
WI5771300001Medicare NSC
WI000047338Medicare PIN