Provider Demographics
NPI:1588634208
Name:HEALTHVIEW EYE CARE CENTER, SC
Entity Type:Organization
Organization Name:HEALTHVIEW EYE CARE CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPOA/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-223-4003
Mailing Address - Street 1:120 DEHNE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:WI
Mailing Address - Zip Code:54421-9589
Mailing Address - Country:US
Mailing Address - Phone:715-223-4003
Mailing Address - Fax:715-223-4417
Practice Address - Street 1:120 DEHNE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:WI
Practice Address - Zip Code:54421-9589
Practice Address - Country:US
Practice Address - Phone:715-223-4003
Practice Address - Fax:715-223-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38715100Medicaid
WI=========019OtherBCBS GROUP #
WI38715100Medicaid
WI=========OtherFEDERAL TAX ID #