# NORTHEAST WISCONSIN VISION CENTER, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295715415
- **Authorized official:** ERIC M LARSON M.D. (PRESIDENT)
- **Authorized official phone:** (920) 232-6550

## Contact information

- **Practice address:** 2130 S WASHBURN ST, OSHKOSH, WI 54904-8949
- **Practice address phone:** (920) 232-6550
- **Practice address fax:** (920) 232-6552
- **Mailing address:** PO BOX 2723, OSHKOSH, WI 54903-2723

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/23/2006
- **Last updated:** 01/16/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32863800 | — | WI |