Healthcare Provider Details

I. General information

NPI: 1730165861
Provider Name (Legal Business Name): CALLIE ENYART O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 W NETHERWOOD RD
OREGON WI
53575-1100
US

IV. Provider business mailing address

185 W NETHERWOOD RD
OREGON WI
53575-1100
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-3579
  • Fax: 608-835-5828
Mailing address:
  • Phone: 608-835-3579
  • Fax: 608-835-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2856
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: