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Organization

COLLEEN HENNELLY, O.D.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. COLLEEN PATRICIA HENNELLY O.D. (OWNER)
(773) 350-1085
Entity
Organization

Contact information

Practice address
3601 PAGE DR, # 4, PLOVER, WI 54467-4034
(773) 350-1085
Mailing address
3601 PAGE DR, # 4, PLOVER, WI 54467-4034
(773) 350-1085

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3237
WI

Other

Enumeration date
05/06/2007
Last updated
10/25/2011
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