Organization
EYE CLINIC OF WISCONSIN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY GODDARD (ADMINISTRATOR)
(715) 261-8557
Entity
Organization
Contact information
Practice address
409 N CHESTNUT AVE, MARSHFIELD, WI 54449-2000
(715) 261-8557
Mailing address
800 N 1ST ST, WAUSAU, WI 54403-4754
(715) 261-8500
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32667800
—
WI
Enumeration date
09/02/2022
Last updated
09/14/2022
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