Organization
KIVLIN EYE CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES KIVLIN OD (OWNER OPTOMETRIST)
(715) 235-3838
Entity
Organization
Contact information
Practice address
2303 SCHNEIDER AVE SE, MENOMONIE, WI 54751-7005
(715) 235-3838
(715) 235-3846
Mailing address
2303 SCHNEIDER AVE SE, MENOMONIE, WI 54751-7005
(715) 235-3838
(715) 235-3846
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1539035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0523040001
DMERC
WI
05
—
38564800
—
WI
Enumeration date
11/30/2006
Last updated
02/12/2008
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