Organization
VISIONWORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LA SUSA (OPTOMETRIST)
(414) 416-0457
Entity
Organization
Contact information
Practice address
1437 S. MAIN ST., WEST BEND, WI 53095
(262) 334-1925
Mailing address
1437 S. MAIN ST., WEST BEND, WI 53095
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3336-35
WI
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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