Organization
OPTICAL FASHIONS LTD
Active
Parent organization
OPTICAL FASHIONS LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
OPTICAL FASHIONS LTD
Authorized official
SUZANNE M EKHOFF (INSURANCE MANAGER)
(608) 782-7127
Entity
Organization
Contact information
Practice address
814 S MAIN ST STE A, HOLMEN, WI 54636-9632
(608) 782-7127
(608) 399-3097
Mailing address
2104 STATE ROAD 16, LA CROSSE, WI 54601-3046
(608) 782-7127
(608) 782-7124
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2705
WI
152W00000X
Optometrist
3116
WI
152W00000X
Optometrist
3129
WI
152W00000X
Optometrist
3359
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100020764
—
WI
05
—
100039841
—
WI
05
—
38602800
—
WI
05
—
38645900
—
WI
05
—
38709300
—
WI
Enumeration date
12/01/2017
Last updated
12/01/2017
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