Provider Demographics
NPI:1194736892
Name:CENTER OPTICAL, INC.
Entity type:Organization
Organization Name:CENTER OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-647-7369
Mailing Address - Street 1:132 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2225
Mailing Address - Country:US
Mailing Address - Phone:608-647-7369
Mailing Address - Fax:608-647-2292
Practice Address - Street 1:132 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2225
Practice Address - Country:US
Practice Address - Phone:608-647-7369
Practice Address - Fax:608-647-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIMD88588152W00000X
WI03945156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38718500Medicaid
WI1044060OtherPHYSICIANS PLUS HMO
WI098002OtherVIPA
WI38718500OtherBLUE CROSS/BLUE SHIELD
WI098002OtherVIPA