Organization
MENOMONIE EYE & OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS J KOMRO OD (AUTHORIZED MEMBER)
(715) 235-2855
Entity
Organization
Contact information
Practice address
520 WILSON AVE, MENOMONIE, WI 54751-2516
(715) 235-2855
(715) 235-9436
Mailing address
520 WILSON AVE, MENOMONIE, WI 54751-2516
(715) 235-2855
(715) 235-9436
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38721600
—
WI
Enumeration date
06/28/2007
Last updated
08/22/2020
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