Organization
STATELINE VISION CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW M JOSEPHS O.D. (SOLE PROPRIETOR)
(608) 325-7200
Entity
Organization
Contact information
Practice address
250 N 18TH AVE STE 105, MONROE, WI 53566-1482
(920) 216-3133
Mailing address
250 N 18TH AVE STE 105, MONROE, WI 53566-1482
(608) 325-7200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3082
WI
Other
Enumeration date
03/17/2015
Last updated
09/16/2020
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