Provider Demographics
NPI:1427579218
Name:KOLB, CAROLYN (OD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KOLB
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 1:13672 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5697
Mailing Address - Country:US
Mailing Address - Phone:608-658-4245
Mailing Address - Fax:
Practice Address - Street 1:113 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2404
Practice Address - Country:US
Practice Address - Phone:715-723-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3472-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist