Provider Demographics
NPI:1427187533
Name:HERSLOF'S, INC
Entity Type:Organization
Organization Name:HERSLOF'S, INC
Other - Org Name:HERSLOF OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-462-1300
Mailing Address - Street 1:12000 W CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2116
Mailing Address - Country:US
Mailing Address - Phone:414-462-1300
Mailing Address - Fax:
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1409
Practice Address - Country:US
Practice Address - Phone:414-453-5360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0294980004Medicare NSC