Organization
RADIANT EYES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE SHIRLEY AVGOULAS OD (OPTOMETRIST)
(262) 490-0275
Entity
Organization
Contact information
Practice address
W248N5233 EXECUTIVE DR UNIT 200, SUSSEX, WI 53089-4318
(262) 304-0080
(262) 304-0081
Mailing address
197 S GOLDEN VISTA CT, OCONOMOWOC, WI 53066-8635
(262) 490-0275
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
06/14/2024
Last updated
07/13/2024
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