Organization · NPI-2

1 Vision S.C.

Optometrist · Shawano, WI

NPI number1033197397
StatusActive
Last updated in NPPESMay 17, 2022

Details

NPI
1033197397
Entity type
Organization (NPI-2)
Legal business name
1 Vision S.C.
Organization subpart
No
Enumeration date
Jan 6, 2006
Certification date
May 17, 2022
Last updated
May 17, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist2324WIYes

Practice location

150a County Rd B
Shawano, WI 54166-7072

Phone 715-526-3163 · Fax 715-526-4019

Mailing address

Po Box 513
Shawano, WI 54166-0513

Phone 715-526-3163 · Fax 715-526-4019

Authorized official

Thomas G Peterson
O.D. - President
7155263163

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