Provider Demographics
NPI:1497953632
Name:HERMAN ADVANCED FAMILY EYECARE
Entity Type:Organization
Organization Name:HERMAN ADVANCED FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-568-1373
Mailing Address - Street 1:510 2ND ST
Mailing Address - Street 2:PO BOX 336
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-9009
Mailing Address - Country:US
Mailing Address - Phone:715-924-3660
Mailing Address - Fax:715-924-3937
Practice Address - Street 1:510 2ND ST
Practice Address - Street 2:
Practice Address - City:CHETEK
Practice Address - State:WI
Practice Address - Zip Code:54728-9009
Practice Address - Country:US
Practice Address - Phone:715-924-3660
Practice Address - Fax:715-924-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38723600Medicaid
WI0000047945Medicare NSC
WI000047945Medicare PIN