Organization
HAYWARD FAMILY EYE CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY FREDERIKSEN O.D. (OWNER/OPTOMETRIST)
(715) 271-9899
Entity
Organization
Contact information
Practice address
15569 RAILROAD ST, SUITE 301, HAYWARD, WI 54843-5706
(715) 634-8616
Mailing address
1200 PARK CREEK CT, FALL CREEK, WI 54742-5316
(715) 271-9899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2235-35
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38577900
—
WI
Enumeration date
05/25/2016
Last updated
01/12/2017
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