Organization
EYE CLINIC OF THE FOX VALLEY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN S DUDLEY MD (PRESIDENT)
(920) 236-3540
Entity
Organization
Contact information
Practice address
503 DOCTORS CT, OSHKOSH, WI 54901-2025
(920) 236-3540
(920) 236-3558
Mailing address
503 DOCTORS CT, OSHKOSH, WI 54901-2025
(920) 236-3540
(920) 236-3558
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TPA2317
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32781900
—
WI
01
—
CI7005
RAILRAOD MEDICARE FOR OD
WI
01
—
CP7959
RAILROAD MEDICARE
WI
Enumeration date
08/29/2006
Last updated
01/16/2013
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