Provider Demographics
NPI:1528622669
Name:BARNETT WAMBOLDT EYECARE, SC
Entity type:Organization
Organization Name:BARNETT WAMBOLDT EYECARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-653-0100
Mailing Address - Street 1:10314 83RD PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2023
Mailing Address - Country:US
Mailing Address - Phone:262-705-7430
Mailing Address - Fax:
Practice Address - Street 1:6116 39TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7012
Practice Address - Country:US
Practice Address - Phone:262-653-0100
Practice Address - Fax:262-653-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARNETT WAMBOLDT EYECARE, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty