Provider Demographics
NPI:1497960876
Name:DEAN M SPRINGER EYECARE INC
Entity Type:Organization
Organization Name:DEAN M SPRINGER EYECARE INC
Other - Org Name:SPRINGER EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-637-2020
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-0170
Mailing Address - Country:US
Mailing Address - Phone:715-637-2020
Mailing Address - Fax:715-637-3140
Practice Address - Street 1:341 E LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1502
Practice Address - Country:US
Practice Address - Phone:715-637-2020
Practice Address - Fax:715-637-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2109035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38528100Medicaid
WI87019Medicare ID - Type Unspecified
WI000015036Medicare PIN
WI38528100Medicaid
WI4756400002Medicare NSC