Healthcare Provider Details

I. General information

NPI: 1801729827
Provider Name (Legal Business Name): JOHN MICHAEL LATHAM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 WI 16
LA CROSSE WI
54601-3046
US

IV. Provider business mailing address

1321 PINECREST LN
ONALASKA WI
54650-3456
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-7127
  • Fax:
Mailing address:
  • Phone: 608-391-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4142-35
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: