Individual
KIM TAVENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
923 ELIZA ST, GREEN BAY, WI 54301-3234
(920) 965-4700
(920) 965-4701
Mailing address
923 ELIZA ST, GREEN BAY, WI 54301-3234
(920) 965-4700
(920) 965-4701
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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