Organization
SODERBERG EYE CARE CENTER SC
Active
Other names
Dennis R. Soderberg O. D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS RAYMOND SODERBERG O. D. (PRESIDENT)
(715) 684-3310
Entity
Organization
Contact information
Practice address
1620 10TH AVE, BALDWIN, WI 54002-9033
(715) 684-3310
(715) 684-4560
Mailing address
1620 10TH AVE, BALDWIN, WI 54002-9033
(715) 684-3310
(715) 684-4560
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1396
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130000518
WEA
WI
01
—
22-12358
MEDICA
MN
05
—
234200600
—
MN
05
—
38411800
—
WI
01
—
92530S0
BCBS
MN
Enumeration date
08/31/2006
Last updated
05/14/2013
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