Provider Demographics
NPI:1386787703
Name:BADGER OPTICAL OF SHEBOYGAN INC
Entity type:Organization
Organization Name:BADGER OPTICAL OF SHEBOYGAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICAIN, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-452-2020
Mailing Address - Street 1:4091 STATE ROAD 28
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2848
Mailing Address - Country:US
Mailing Address - Phone:920-452-2020
Mailing Address - Fax:920-452-6424
Practice Address - Street 1:4091 STATE ROAD 28
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-2848
Practice Address - Country:US
Practice Address - Phone:920-452-2020
Practice Address - Fax:920-452-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty