Stateline Vision Center LLC

NPI #1104219039 in Monroe, Wisconsin

Provider Information

NPI Number: 1104219039
Entity Type: Organization
Organization Name: Stateline Vision Center LLC
Primary Specialty: Optometrist
Enumeration Date: Mar 17, 2015
Last Updated: Sep 16, 2020

Practice Location

Address: 250 N 18TH AVE STE 105
City: Monroe
State: Wisconsin
ZIP Code: 53566-1482
Phone: (920) 216-3133

Authorized Official

Name: ANDREW M JOSEPHS, O.D.
Title: SOLE PROPRIETOR
Phone: (608) 325-7200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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