Provider Demographics
NPI:1073647749
Name:EYE CARE ASSOCIATES OF BARABOO S.C.
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF BARABOO S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RITZENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-356-3972
Mailing Address - Street 1:222 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2135
Mailing Address - Country:US
Mailing Address - Phone:608-356-3972
Mailing Address - Fax:
Practice Address - Street 1:222 4TH AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2135
Practice Address - Country:US
Practice Address - Phone:608-356-3972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1695332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0806560001Medicare NSC