Provider Demographics
NPI:1215465083
Name:NORTHVIEW EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHVIEW EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-234-3113
Mailing Address - Street 1:1801 W KNAPP ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1381
Mailing Address - Country:US
Mailing Address - Phone:715-234-3113
Mailing Address - Fax:715-234-2339
Practice Address - Street 1:1801 W KNAPP ST STE 3
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868
Practice Address - Country:US
Practice Address - Phone:715-234-3113
Practice Address - Fax:715-234-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty