Healthcare Provider Details

I. General information

NPI: 1336101161
Provider Name (Legal Business Name): CORR OPTICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 1ST ST
NEENAH WI
54956
US

IV. Provider business mailing address

250 1ST ST
NEENAH WI
54956
US

V. Phone/Fax

Practice location:
  • Phone: 920-722-2844
  • Fax: 920-722-1242
Mailing address:
  • Phone: 920-722-2844
  • Fax: 920-722-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JOHN W JANKE
Title or Position: OWNER OPTICIAN
Credential:
Phone: 920-722-2844