Organization
MAYVILLE VISION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CASSANDRE BEZOLD HETZER O.D. (OPTOMETRIST/PRESIDENT)
(920) 387-3180
Entity
Organization
Contact information
Practice address
935 HORICON ST, MAYVILLE, WI 53050-1428
(920) 387-3180
(920) 387-9636
Mailing address
935 HORICON ST, MAYVILLE, WI 53050-1428
(920) 387-3180
(920) 387-9636
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
WI 2915-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38617900
—
WI
Enumeration date
08/05/2008
Last updated
06/17/2009
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