Provider Demographics
NPI:1962615807
Name:SPRINGER, DEAN MARVIN (OD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MARVIN
Last Name:SPRINGER
Suffix:
Gender:M
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:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-0170
Mailing Address - Country:US
Mailing Address - Phone:715-637-5909
Mailing Address - Fax:
Practice Address - Street 1:341 E LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1502
Practice Address - Country:US
Practice Address - Phone:715-637-2020
Practice Address - Fax:715-637-3140
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2109035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63397Medicare UPIN