Organization
FAMILY VISION & CONTACT LENS CTRS SC
Active
Parent organization
FAMILY VISION & CONTACT LENS CTRS SC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY VISION & CONTACT LENS CTRS SC
Authorized official
DR. ROBERT LAWRENCE FAIT OD (OWNER)
(262) 763-0117
Entity
Organization
Contact information
Practice address
920 GREENWALD CT, SUITE 300, MUKWONAGO, WI 53149-1711
(262) 363-1717
(262) 363-1726
Mailing address
PO BOX 630, 309 MCHENRY ST, BURLINGTON, WI 53105
(262) 763-0117
(262) 763-0119
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/28/2008
Last updated
04/09/2012
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