Organization
JAN'S OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA RUCH (OWNER)
(920) 324-8608
Entity
Organization
Contact information
Practice address
223 E MAIN ST, WAUPUN, WI 53963-2019
(920) 324-8608
(920) 324-8699
Mailing address
PO BOX 163, WAUPUN, WI 53963-0163
(920) 324-8608
(920) 324-8699
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3069-035
WI
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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