Individual
STEVEN SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
428 W MAIN ST, MOUNT HOREB, WI 53572-1902
(608) 437-3377
(608) 437-5063
Mailing address
PO BOX 350, 428 W. MAIN STREET, MOUNT HOREB, WI 53572-0350
(608) 437-3377
(608) 437-5063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2640
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38595200
—
WI
Enumeration date
12/21/2005
Last updated
07/09/2010
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