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General NPI Number Information
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NPI Number | 1104471572
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Entity Type | Individual
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Provider Name | JUWARIA DIN OD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 4163 N OAKLAND AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-2027
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Country | US
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Telephone | 414-455-8131
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Fax |
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Provider Business Mailing Address
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Address Line | 2903 RICHARDSON ST
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City | FITCHBURG
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State | WI
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Zip | 53711-5288
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Country | US
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Telephone | 608-332-1633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3579-35
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License Number State | WI
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