1013060136 NPI number — DONALD E DLOUHY O.D.

Table of content: DONALD E DLOUHY O.D. (NPI 1013060136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013060136 NPI number — DONALD E DLOUHY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DLOUHY
Provider First Name:
DONALD
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013060136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12728 W HAMPTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53007-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-781-8693
Provider Business Mailing Address Fax Number:
262-781-1468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12728 W HAMPTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53007-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-781-8693
Provider Business Practice Location Address Fax Number:
262-781-1468
Provider Enumeration Date:
01/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1863-035 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 391466974 . This is a "EYEMED" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 915497 . This is a "VIPA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: DE41133 . This is a "SPECTERA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391466974 . This is a "NVA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 028578001 . This is a "NATIONAL SUPPLIER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38519900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391466974 . This is a "VCP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391466974 . This is a "VSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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