Individual
JAMES CHARLES FORNES , OD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
301 BAY PARK SQ, GREEN BAY, WI 54304-5104
(920) 499-3511
(920) 499-9215
Mailing address
301 BAY PARK SQ, GREEN BAY, WI 54304-5104
(920) 499-3511
(920) 499-9215
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1465
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38504800
—
WI
Enumeration date
05/17/2006
Last updated
07/08/2007
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