Organization
ANTIGO VISION CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ARTHUR KJOME OD (PRESIDENT)
(715) 623-2180
Entity
Organization
Contact information
Practice address
714 3RD AVE, ANTIGO, WI 54409-2044
(715) 623-2180
(715) 623-7244
Mailing address
714 3RD AVE, PO BOX 238, ANTIGO, WI 54409-2044
(715) 623-2180
(715) 623-7244
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1477-35
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38563700
—
WI
Enumeration date
11/05/2007
Last updated
08/26/2008
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