Provider Demographics
NPI:1386786754
Name:SATEREN, CAMILE D (OD)
Entity type:Individual
Prefix:
First Name:CAMILE
Middle Name:D
Last Name:SATEREN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAMILE
Other - Middle Name:D
Other - Last Name:DOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1615 MAPLE LANE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806
Mailing Address - Country:US
Mailing Address - Phone:715-685-5513
Mailing Address - Fax:715-682-4022
Practice Address - Street 1:1615 MAPLE LANE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-685-5513
Practice Address - Fax:715-682-4022
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000012004OtherMEDICARE CLINIC ID
WI38593600Medicaid
WI120040006OtherMEDICARE PTAN
WI204728664OtherCLINIC TAX ID
WI5705960001OtherMEDICARE DMERC ID
WI38593600Medicaid