Organization
WOLF RIVER EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL K THOMPSON O.D. (OWNER)
(920) 982-4561
Entity
Organization
Contact information
Practice address
1923 N SHAWANO ST, SUITE B, NEW LONDON, WI 54961-7510
(920) 982-4561
(920) 982-9811
Mailing address
1923 N SHAWANO ST, SUITE B, NEW LONDON, WI 54961-7510
(920) 982-4561
(920) 982-9811
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2483-035
WI
152W00000X
Optometrist
2752-035
WI
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38719600
—
WI
Enumeration date
10/03/2006
Last updated
07/07/2015
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