Organization
1 VISION S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS G PETERSON O.D. (O.D. - PRESIDENT)
(715) 526-3163
Entity
Organization
Contact information
Practice address
150A COUNTY RD B, SHAWANO, WI 54166-7072
(715) 526-3163
(715) 526-4019
Mailing address
PO BOX 513, SHAWANO, WI 54166-0513
(715) 526-3163
(715) 526-4019
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2324
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38578000
—
WI
01
—
410033786
RAILROAD MEDICARE
WI
Enumeration date
01/06/2006
Last updated
05/17/2022
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