Provider Demographics
NPI:1669585352
Name:ST CROIX FALLS EYE ASSOCIATES INC.
Entity type:Organization
Organization Name:ST CROIX FALLS EYE ASSOCIATES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-483-3259
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-0767
Mailing Address - Country:US
Mailing Address - Phone:715-483-3259
Mailing Address - Fax:608-571-0088
Practice Address - Street 1:108 OAK ST
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837-9547
Practice Address - Country:US
Practice Address - Phone:715-327-8239
Practice Address - Fax:608-571-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38722500Medicaid
WICH8370OtherRR-PTAN CH8370
WI000047430Medicare PIN
WI0321190002Medicare NSC