Provider Demographics
NPI:1134859887
Name:ROCK RIVER OPTICAL LLC
Entity type:Organization
Organization Name:ROCK RIVER OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-728-2350
Mailing Address - Street 1:232 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2228
Mailing Address - Country:US
Mailing Address - Phone:920-542-1501
Mailing Address - Fax:920-542-1503
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2228
Practice Address - Country:US
Practice Address - Phone:920-542-1501
Practice Address - Fax:920-542-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty