Provider Demographics
NPI:1639320278
Name:EAU CLAIRE REFRACTIVE LLC
Entity Type:Organization
Organization Name:EAU CLAIRE REFRACTIVE LLC
Other - Org Name:TLC LASER EYE CENTERS EAU CLAIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-534-2300
Mailing Address - Street 1:16305 SWINGLEY RIDGE RD
Mailing Address - Street 2:STE.300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1777
Mailing Address - Country:US
Mailing Address - Phone:636-534-2300
Mailing Address - Fax:
Practice Address - Street 1:745 KENNEY AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6361
Practice Address - Country:US
Practice Address - Phone:715-838-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center