Antigo Vision Clinic Sc

LBN: Antigo Vision Clinic Sc
Antigo Vision Clinic Sc is an health care organization with primary practice located at 714 3Rd Ave , Antigo WI 54409-2044. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Antigo Vision Clinic Sc can be contacted via phone (715) 623-2180, or through Kjome, Richard Arthur via phone (715) 623-2180.

Contact Information

Primary practice address
714 3Rd Ave Antigo WI 54409-2044
Phone: (715) 623-2180
Fax: (715) 623-7244
Website:
Map and Directions
Authorized official contact:
Name: Kjome, Richard Arthur Doctor of Optometry (OD)
Phone: (715) 623-2180

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1477-35 Wisconsin

Profile Details

NPI number 1295915460
LBN Legal business name Antigo Vision Clinic Sc
DBA Doing business as
Authorized official Kjome, Richard Arthur Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 5th, 2007
Last updated Aug 26th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295915460 NPPES
Wisconsin MEDICAID 38563700

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