Organization
SAMUELSON EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN TA-SAMUELSON OD (OPTOMETRIST)
(608) 437-3377
Entity
Organization
Contact information
Practice address
428 WEST MAIN ST, MOUNT HOREB, WI 53572-2103
(608) 437-3377
(608) 437-5063
Mailing address
428 WEST MAIN ST, PO BOX 350, MOUNT HOREB, WI 53572-2103
(608) 437-3377
(608) 437-5063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38714000
—
WI
Enumeration date
10/04/2006
Last updated
10/01/2010
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