Provider Demographics
NPI:1649507062
Name:RICE LAKE FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:RICE LAKE FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DAWN SVOBODA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-234-1511
Mailing Address - Street 1:2900 S MAIN ST
Mailing Address - Street 2:SUITE NUMBER 15
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2945
Mailing Address - Country:US
Mailing Address - Phone:715-234-1511
Mailing Address - Fax:715-234-1511
Practice Address - Street 1:2900 S MAIN ST
Practice Address - Street 2:SUITE NUMBER 15
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2945
Practice Address - Country:US
Practice Address - Phone:715-234-1511
Practice Address - Fax:715-234-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty