Organization
NORTHEAST WISCONSIN VISION CENTER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC M LARSON M.D. (PRESIDENT)
(920) 232-6550
Entity
Organization
Contact information
Practice address
2130 S WASHBURN ST, OSHKOSH, WI 54904-8949
(920) 232-6550
(920) 232-6552
Mailing address
PO BOX 2723, OSHKOSH, WI 54903-2723
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32863800
—
WI
Enumeration date
01/23/2006
Last updated
01/16/2024
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