Healthcare Provider Details

I. General information

NPI: 1700938867
Provider Name (Legal Business Name): MARY JO BYERS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N MAIN ST
IOLA WI
54945-9120
US

IV. Provider business mailing address

135 N MAIN ST P.O. BOX 302
IOLA WI
54945-9120
US

V. Phone/Fax

Practice location:
  • Phone: 715-445-3553
  • Fax: 715-445-4970
Mailing address:
  • Phone: 715-445-3553
  • Fax: 715-445-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2491
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: