Provider Demographics
NPI:1417179052
Name:NHH VISIONGROUP, S.C.
Entity Type:Organization
Organization Name:NHH VISIONGROUP, S.C.
Other - Org Name:VISION SOURCE FLORENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:H
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-528-5331
Mailing Address - Street 1:433 FLORENCE AVE.
Mailing Address - Street 2:PO BOX 421
Mailing Address - City:FLORENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54121
Mailing Address - Country:US
Mailing Address - Phone:715-528-5331
Mailing Address - Fax:715-528-5332
Practice Address - Street 1:433 FLORENCE AVE.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:WI
Practice Address - Zip Code:54121
Practice Address - Country:US
Practice Address - Phone:715-528-5331
Practice Address - Fax:715-528-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38578900Medicaid
WI0227080003Medicare NSC
WI000087585Medicare PIN
WI38578900Medicaid