Individual
KENNETH G FORSYTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1302 BROADWAY, WISCONSIN DELLS, WI 53965-1358
(608) 254-8383
(608) 253-6223
Mailing address
1302 BROADWAY, WISCONSIN DELLS, WI 53965-1358
(608) 254-8383
(608) 253-6223
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1318-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006698
PHYSICIANS PLUS
WI
05
—
38573400
—
WI
01
—
60090
DEAN HEALTH INSURANCE
WI
Enumeration date
05/17/2006
Last updated
04/29/2014
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