Individual
RICHARD A KJOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
714 3RD AVE, ANTIGO, WI 54409-2044
(715) 623-2180
Mailing address
PO BOX 238, ANTIGO, WI 54409-0238
(715) 623-2180
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1477-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38563700
—
WI
Enumeration date
12/28/2006
Last updated
07/08/2007
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