Organization
SIREN FAMILY EYECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN DARRELL SMITH O.D. (MEMBER)
(715) 349-2733
Entity
Organization
Contact information
Practice address
24082 STATE ROAD 35, SIREN, WI 54872
(715) 349-2733
(715) 349-2744
Mailing address
P.O. BOX 290, 24082 STATE ROAD 35, SIREN, WI 54872-0290
(715) 349-2733
(715) 349-2744
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2728
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-00884
MEDICA EYEWEAR PIN
WI
01
—
38725900
GROUP HEALTH OF EAU CLAIRE
WI
05
—
38725900
—
WI
01
—
47955
SPECTERA/OPTUM HEALTH
WI
01
—
57568
DAVIS VISION
WI
Enumeration date
06/11/2007
Last updated
06/21/2011
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