Organization
KIVLIN EYE CLINIC, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES B KIVLIN OD (OWNER/OPTOMETRIST)
(715) 263-2600
Entity
Organization
Contact information
Practice address
370 3RD AVE, CLEAR LAKE, WI 54005
(715) 263-2600
(715) 263-3233
Mailing address
PO BOX 15, 370 3RD AVE, CLEAR LAKE, WI 54005
(715) 263-2600
(715) 263-3233
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1539-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0523040002
DMERC
WI
05
—
38702400
—
WI
Enumeration date
08/28/2007
Last updated
08/31/2009
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