Provider Demographics
NPI:1053481473
Name:REDMAN & GELINAS SC
Entity type:Organization
Organization Name:REDMAN & GELINAS SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-356-2262
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-2797
Mailing Address - Country:US
Mailing Address - Phone:715-479-9390
Mailing Address - Fax:715-477-1752
Practice Address - Street 1:141 B SOUTH WILLOW STREET
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521
Practice Address - Country:US
Practice Address - Phone:715-479-9390
Practice Address - Fax:715-477-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1314520003Medicare NSC