Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1863-035 | WI |
NPI | 1013060136 |
---|---|
Provider Name | Donald E Dlouhy |
First Address | Butler, WI 53007-1602 |
Second Address | Butler, WI 53007-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2007 |
Last Update Date | 15/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028578001 | NATIONAL SUPPLIER (01) | WI |
38519900 | (05) | WI |
391466974 | EYEMED (01) | WI |
391466974 | NVA (01) | WI |
391466974 | VCP (01) | WI |
391466974 | VSP (01) | WI |
915497 | VIPA (01) | WI |
DE41133 | SPECTERA (01) | WI |
T61777 | (02) | WI |