Organization
RACINE OPTICAL CO., FAMILY VISION CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN ROSENBERG OD (CEO)
(262) 634-4430
Entity
Organization
Contact information
Practice address
217 6TH ST, RACINE, WI 53403-1213
(262) 634-4430
(262) 634-1890
Mailing address
217 6TH ST, RACINE, WI 53403-1213
(262) 634-4430
(262) 634-1890
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
2220
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000047405
MEDICARE GROUP NUMBER
WI
05
—
38574400
—
WI
01
—
DG4459
RAILROAD MEDICARE PART B
WI
Enumeration date
04/02/2007
Last updated
06/11/2020
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