Provider Demographics
NPI:1558547810
Name:RIVER VALLEY VISION, S.C.
Entity Type:Organization
Organization Name:RIVER VALLEY VISION, S.C.
Other - Org Name:MONSON EYECARE CENTER, S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KABAT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-832-4946
Mailing Address - Street 1:2600 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-832-4946
Mailing Address - Fax:715-832-0699
Practice Address - Street 1:2600 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-832-4946
Practice Address - Fax:715-832-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1355035152W00000X
WI3035-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38440200Medicaid
WI0565230001Medicare NSC
WI000087062Medicare PIN