Organization
EYE CLINIC OF WISCONSIN, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY GODDARD (COO)
(715) 261-8557
Entity
Organization
Contact information
Practice address
109 STATE HWY 64, ANTIGO, WI 54409
(715) 623-6662
(715) 623-2400
Mailing address
800 N FIRST ST, WAUSAU, WI 54403-4754
(715) 261-8500
(715) 261-8665
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32667800
—
WI
Enumeration date
11/30/2005
Last updated
01/21/2025
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