| Barnett Wamboldt Eyecare, Sc | |
|
6116-39 Ave Kenosha WI 53142 | |
| (262) 653-0100 | |
| (262) 653-0200 |
| Full Name | Barnett Wamboldt Eyecare, Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6116-39 Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Debra Jeanne Barnett-wamboldt (PRESIDENT) |
| Authorized Official Contact | 2626973665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Barnett Wamboldt Eyecare, Sc 6116-39 Ave Kenosha WI 53142 Ph: (262) 653-0100 | Barnett Wamboldt Eyecare, Sc 6116-39 Ave Kenosha WI 53142 Ph: (262) 653-0100 |
| NPI Number | 1497905129 |
|---|---|
| Provider Enumeration Date | 09/30/2008 |
| Last Update Date | 01/28/2009 |
| Medicare PECOS PAC ID | 3072533462 |
|---|---|
| Medicare Enrollment ID | O20051130000476 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497905129 | NPI | - | NPPES |
| 38585300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 2407-035 (Wisconsin) | Primary |
| Provider Name | Debra J Barnett |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1831183540 PECOS PAC ID: 5799715561 Enrollment ID: I20050822000505 |
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