Organization
ANTIGO EYE CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KAY BARTLETTE (OFFICE MANAGER)
(715) 623-3620
Entity
Organization
Contact information
Practice address
810 5TH AVE, ANTIGO, WI 54409-1937
(715) 623-3620
(715) 623-3333
Mailing address
810 5TH AVE, P O BOX 628, ANTIGO, WI 54409-1937
(715) 623-3620
(715) 623-3333
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T61453
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38708600-38553700
—
WI
Enumeration date
09/20/2006
Last updated
07/10/2008
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