MEDICARE: DR. BARRY ALBERT DAHLGREN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	WI1460	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235281270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY ALBERT DAHLGREN O.D.

Provider Business Mailing Address
First Line	:	8535 W TRIPOLI AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53228-1723
Country	:	US
Telephone Number	:	414-543-7383
Fax Number	:

Provider Business Practice Location Address
First Line	:	3670 S 108TH ST
Second Line	:	STE 204
City	:	GREENFIELD
State	:	WI
Zip	:	53228-1237
Country	:	US
Telephone Number	:	414-453-1010
Fax Number	:	414-425-4230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	01/23/2017

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