Provider Demographics
NPI:1568835544
Name:BURNETT, JOLANDA (ABOC)
Entity type:Individual
Prefix:
First Name:JOLANDA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1550
Mailing Address - Country:US
Mailing Address - Phone:715-502-3464
Mailing Address - Fax:715-502-3463
Practice Address - Street 1:1645 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1550
Practice Address - Country:US
Practice Address - Phone:715-502-3464
Practice Address - Fax:715-502-3463
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician