Provider Demographics
NPI:1083718183
Name:OPTICAL FASHIONS LTD
Entity Type:Organization
Organization Name:OPTICAL FASHIONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-782-7127
Mailing Address - Street 1:2104 STATE RD 16
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3046
Mailing Address - Country:US
Mailing Address - Phone:608-782-7127
Mailing Address - Fax:608-782-7124
Practice Address - Street 1:2104 STATE RD 16
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-782-7127
Practice Address - Fax:608-782-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1586152W00000X
WI1575152W00000X
WI2705152W00000X
WI3116152W00000X
WI3129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38645900Medicaid
WI38509300Medicaid
WI38602800Medicaid
WI100020764Medicaid
WI38512500Medicaid
00687036Medicare UPIN
WI38512500Medicaid
WI38602800Medicaid
WICO1020Medicare PIN
U71283Medicare UPIN
WI100020764Medicaid
T61709Medicare UPIN
00787036Medicare UPIN
WI38645900Medicaid
WI0537530001Medicare NSC
WI000387036Medicare PIN