Individual
STEPHEN J PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3805B SPRING ST, SUITE 140, RACINE, WI 53405-1641
(262) 637-8835
(262) 635-8027
Mailing address
3805B SPRING ST, SUITE 140, RACINE, WI 53405-1641
(262) 637-8835
(262) 635-8027
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1963-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38583200
—
WI
Enumeration date
07/24/2006
Last updated
04/18/2011
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