Provider Demographics
NPI:1629235031
Name:FLUEGGE OPTICAL
Entity Type:Organization
Organization Name:FLUEGGE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FLUEGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-534-6090
Mailing Address - Street 1:920 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185
Mailing Address - Country:US
Mailing Address - Phone:262-534-6090
Mailing Address - Fax:262-534-2277
Practice Address - Street 1:920 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185
Practice Address - Country:US
Practice Address - Phone:262-534-6090
Practice Address - Fax:262-534-2277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLUEGGE OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty