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Organization

WAUTOMA EYE CLINIC S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN L. MECKELBERG OD (OWNER)
(920) 787-3837
Entity
Organization

Contact information

Practice address
N2577 PLAZA RD, WAUTOMA, WI 54982-7706
(920) 787-3837
(920) 787-1613
Mailing address
PO BOX 366, N2577 PLAZA ROAD, WAUTOMA, WI 54982-0366
(920) 787-3837
(920) 787-1613

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2056
WI

Other

Enumeration date
03/20/2007
Last updated
08/22/2020
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