Organization
AGNESIAN HEALTHCARE INC
Active
Other names
SSM Health Eye Care, Fond du Lac Regional Optical
Organization subpart
No
Provider details
NPI number
Authorized official
AMY JO GRINNELL (VP FINANCE)
(608) 260-3586
Entity
Organization
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-8316
Mailing address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-8316
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38437100
—
WI
Enumeration date
04/18/2008
Last updated
06/05/2024
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