Provider Demographics
NPI:1366416661
Name:HUNT, TAMI SUE (OD)
Entity type:Individual
Prefix:DR
First Name:TAMI
Middle Name:SUE
Last Name:HUNT
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 1:320 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1424
Mailing Address - Country:US
Mailing Address - Phone:608-848-5168
Mailing Address - Fax:608-848-6012
Practice Address - Street 1:320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1424
Practice Address - Country:US
Practice Address - Phone:608-848-5168
Practice Address - Fax:608-848-6012
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38631300Medicaid
WI38631300Medicaid
WI6024580001Medicare NSC
WI000147995Medicare PIN