Organization
BARNETT WAMBOLDT EYECARE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBRA JEANNE BARNETT-WAMBOLDT O.D. (PRESIDENT)
(262) 697-3665
Entity
Organization
Contact information
Practice address
6116-39 AVE, KENOSHA, WI 53142
(262) 653-0100
(262) 653-0200
Mailing address
6116-39 AVE, KENOSHA, WI 53142
(262) 653-0100
(262) 653-0200
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2407-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38585300
—
WI
Enumeration date
09/30/2008
Last updated
01/28/2009
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