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Individual

SCOTT KENNETH FORSYTHE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
2929 MILTON AVE STE 140, JANESVILLE, WI 53545-0253
(072) 860-8756
Mailing address
5607 BLACK ONYX DR APT 204, MADISON, WI 53718-9161
(608) 963-6793

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3516-35
WI

Other

Enumeration date
08/21/2018
Last updated
08/21/2018
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