Provider Demographics
NPI:1194815233
Name:ORLICH, DOUGLAS MILTON (OD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MILTON
Last Name:ORLICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 STREBLOW ST.
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2084
Mailing Address - Country:US
Mailing Address - Phone:608-783-9770
Mailing Address - Fax:608-783-9770
Practice Address - Street 1:106 S. HOLMEN DR.
Practice Address - Street 2:SUITE 6
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9467
Practice Address - Country:US
Practice Address - Phone:608-526-1177
Practice Address - Fax:608-526-4131
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38505100Medicaid
391406621014OtherBCBS OF WISCONSIN
WI38505100Medicaid