Healthcare Provider Details

I. General information

NPI: 1811815772
Provider Name (Legal Business Name): EMMA FENRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CORMIER RD
GREEN BAY WI
54304-4404
US

IV. Provider business mailing address

1001 CORMIER RD
GREEN BAY WI
54304-4404
US

V. Phone/Fax

Practice location:
  • Phone: 920-499-5873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4152-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: