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Individual

DR. PENNY SUE IVERSON-AMMERAAL

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
2602 SHOPKO DR, MADISON, WI 53704-4074
(608) 249-6967
(608) 249-7245
Mailing address
2201 ZEIER RD, MADISON, WI 53704-7415
(608) 244-4325

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2722
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38607700
WI
Enumeration date
05/11/2006
Last updated
06/29/2017
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