Individual
DR. DENNIS RAYMOND SODERBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1620 10TH AVE, BALDWIN, WI 54002-9033
(715) 684-3310
(715) 684-4560
Mailing address
1620 10TH AVE, BALDWIN, WI 54002-9033
(715) 684-3310
(715) 684-4560
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1396
WI
152W00000X
Optometrist
1549
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-12358
MEDICA
—
05
—
38411800
—
WI
01
—
391170106028
BCBS
WI
01
—
391170106036
COMPCARE
WI
01
—
391170106044
CLAIMS MANAGEMENT
WI
01
—
774002
PREFERRED ONE
—
01
—
795000
HEALTH PARTNERS
—
01
—
92530S0
BCBS
MN
Enumeration date
04/20/2006
Last updated
07/09/2007
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