Provider Demographics
NPI:1205006632
Name:DEAN M SPRINGER EYECARE INC
Entity type:Organization
Organization Name:DEAN M SPRINGER EYECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-637-2020
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54889-0047
Mailing Address - Country:US
Mailing Address - Phone:715-986-4448
Mailing Address - Fax:715-986-4595
Practice Address - Street 1:218 MAPLE ST S
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-8003
Practice Address - Country:US
Practice Address - Phone:715-986-4448
Practice Address - Fax:715-986-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2109035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38705400Medicaid
WI38705400Medicaid