| |
1620 10th Ave, Baldwin, WI 54002-9033 | |
(715) 684-3310 | |
(715) 684-4560 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 1620 10th Ave, Baldwin, Wisconsin |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548371966 | NPI | - | NPPES |
22-12358 | Other | MN | MEDICA |
234200600 | Medicaid | MN | |
92530S0 | Other | MN | BCBS |
130000518 | Other | WI | WEA |
38411800 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1396 (Wisconsin) | Primary |
Mailing Address | Practice Location Address |
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1620 10th Ave, Baldwin, WI 54002-9033 Ph: (715) 684-3310 | 1620 10th Ave, Baldwin, WI 54002-9033 Ph: (715) 684-3310 |
Dr. Dennis Raymond Soderberg, O.D. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1620 10th Ave, Baldwin, WI 54002 Phone: 715-684-3310 Fax: 715-684-4560 |