Organization
CARDINAL FAMILY EYE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB B VERGIN OD (MANAGING PARTNER)
(715) 861-5253
Entity
Organization
Contact information
Practice address
102 E STANLEY ST, THORP, WI 54771-9649
(715) 669-5631
(715) 669-5353
Mailing address
102 E STANLEY ST, PO BOX 468, THORP, WI 54771-9649
(715) 669-5631
(715) 669-5353
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3083-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38726700
—
WI
Enumeration date
09/05/2007
Last updated
02/21/2008
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