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General NPI Number Information
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NPI Number | 1114948221
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Entity Type | Individual
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Provider Name | COLLEEN S HEBERT O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 740 REENA AVE SUITE B
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City | FORT ATKINSON
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State | WI
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Zip | 53538-3145
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Country | US
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Telephone | 920-563-8468
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Fax | 920-563-7018
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Provider Business Mailing Address
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Address Line | 740 REENA AVE SUITE B
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City | FORT ATKINSON
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State | WI
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Zip | 53538-3145
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Country | US
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Telephone | 920-563-8468
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Fax | 920-563-7018
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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 | 2429-035
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License Number State | WI
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