Provider Demographics
NPI:1215342084
Name:DAGGETT, ERIN RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:RENEE
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RENEE
Other - Last Name:KIZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:330 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:HATLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54440-9742
Mailing Address - Country:US
Mailing Address - Phone:715-432-7757
Mailing Address - Fax:
Practice Address - Street 1:200 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4252
Practice Address - Country:US
Practice Address - Phone:715-842-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3344-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist