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General NPI Number Information
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NPI Number | 1235194465
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Entity Type | Individual
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Provider Name | ROBERT A MATHAUS O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | N85W16033 APPLETON AVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3088
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Country | US
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Telephone | 262-251-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 16800 WEST CLEVELAND AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-3533
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Country | US
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Telephone | 262-432-2005
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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 | 2688
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License Number State | WI
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