Individual
TREVOR J BALDWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1721 W MAIN ST, SUN PRAIRIE, WI 53590-3161
(608) 837-7325
(608) 837-7326
Mailing address
1721 W MAIN ST, SUN PRAIRIE, WI 53590-3161
(608) 837-7325
(608) 837-7326
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1926-035
WI
152WC0802X
Corneal and Contact Management Optometrist
1926-035
WI
156FX1201X
Optometric Assistant Technician
—
—
156FX1800X
Optician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000247780
MEDICARE PROVIDER NUMBER
—
Enumeration date
05/23/2006
Last updated
02/08/2021
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