Organization
THIELKE FAMILY EYE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRENT N. THIELKE O.D. (REGISTERED AGENT)
(715) 808-0480
Entity
Organization
Contact information
Practice address
2212 GLACIER DR, SAINT CROIX FALLS, WI 54024-8347
(715) 483-2571
Mailing address
911 WERT RD, HUDSON, WI 54016-7589
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3145-035
WI
152W00000X
Optometrist
3183
MN
Other
Enumeration date
01/05/2015
Last updated
03/09/2015
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