Provider Demographics
NPI:1043665482
Name:STOUGHTON EYE CARE & EYEWEAR LLC
Entity Type:Organization
Organization Name:STOUGHTON EYE CARE & EYEWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-920-5729
Mailing Address - Street 1:2300 US HIGHWAY 51 AND 138
Mailing Address - Street 2:SUITE E
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2080
Mailing Address - Country:US
Mailing Address - Phone:608-205-2293
Mailing Address - Fax:608-205-6813
Practice Address - Street 1:2300 US HIGHWAY 51 AND 138
Practice Address - Street 2:SUITE E
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-2080
Practice Address - Country:US
Practice Address - Phone:608-205-2293
Practice Address - Fax:608-205-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7568380001Medicare NSC