Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1432 | WI |
NPI | 1013021518 |
---|---|
Provider Name | Dr. John Kenneth Morrison |
First Address | Delavan, WI 53115-0910 |
Second Address | Delavan, WI 53115-2340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 26/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
516110 | DEAN HEALTH HMO (01) | WI |
T62810 | (02) | WI |