Provider Demographics
NPI:1346344678
Name:SODERBERG EYE CARE CENTER
Entity Type:Organization
Organization Name:SODERBERG EYE CARE CENTER
Other - Org Name:DENNIS R. SODERBERG O.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SODERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-246-4441
Mailing Address - Street 1:228 PAPERJACK DR
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2430
Mailing Address - Country:US
Mailing Address - Phone:715-246-4441
Mailing Address - Fax:715-246-3250
Practice Address - Street 1:228 PAPERJACK DR
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2430
Practice Address - Country:US
Practice Address - Phone:715-246-4441
Practice Address - Fax:715-246-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-14005OtherMEDICA
WI371170106044OtherBCBS
WI38501900Medicaid
MN48421OtherHEALTH PARTNERS
MN22-14005OtherMEDICA
MN48421OtherHEALTH PARTNERS