Provider Demographics
NPI:1194873950
Name:MARQUARDT, LOUISE E (OD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:E
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:E
Other - Last Name:KALLAAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:N333 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-8107
Mailing Address - Country:US
Mailing Address - Phone:920-750-9176
Mailing Address - Fax:
Practice Address - Street 1:4155 N GALAXY DR STE 101
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-2728
Practice Address - Country:US
Practice Address - Phone:920-993-0790
Practice Address - Fax:920-993-0791
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2552 - 035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI87335 0004Medicare ID - Type Unspecified
WIU45056-01Medicare UPIN