Provider Demographics
NPI:1902918493
Name:NORTHWOODS FAMILY EYECARE, LLC
Entity Type:Organization
Organization Name:NORTHWOODS FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:GLANTZ
Authorized Official - Last Name:ARNESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-723-9187
Mailing Address - Street 1:113 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2404
Mailing Address - Country:US
Mailing Address - Phone:715-723-9187
Mailing Address - Fax:
Practice Address - Street 1:113 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2404
Practice Address - Country:US
Practice Address - Phone:715-723-9187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
WI0246180001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38714400Medicaid
WI47182Medicare PIN
WI0246180001Medicare NSC