Provider Demographics
NPI:1104564269
Name:AUSDEMORE, JOSEPHINE ROSEMARY (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:ROSEMARY
Last Name:AUSDEMORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27566 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51576-3764
Mailing Address - Country:US
Mailing Address - Phone:402-681-5707
Mailing Address - Fax:
Practice Address - Street 1:1459 W SERVICE DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-2512
Practice Address - Country:US
Practice Address - Phone:507-452-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist