Healthcare Provider Details

I. General information

NPI: 1245231836
Provider Name (Legal Business Name): DONNA ANNE HIGGINS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W BLACKHAWK AVE
PRAIRIE DU CHIEN WI
53821-1422
US

IV. Provider business mailing address

PO BOX 379
PRAIRIE DU CHIEN WI
53821-0379
US

V. Phone/Fax

Practice location:
  • Phone: 608-326-6223
  • Fax:
Mailing address:
  • Phone: 608-326-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1771035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: