Organization
ADVANCED FAMILY EYECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL R EVERTS OD (OWNER/PRESIDENT)
(715) 258-8168
Entity
Organization
Contact information
Practice address
308 W FULTON ST, WAUPACA, WI 54981-1422
(715) 258-8168
(715) 258-8436
Mailing address
308 W FULTON ST, WAUPACA, WI 54981-1422
(715) 258-8168
(715) 258-8436
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2753
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38716100
—
WI
Enumeration date
11/01/2006
Last updated
07/18/2011
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