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General NPI Number Information
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NPI Number | 1700083169
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Entity Type | Individual
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Provider Name | ANDREW M JOSEPHS OD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 250 N 18TH AVE SUITE 105
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City | MONROE
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State | WI
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Zip | 53566-1482
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Country | US
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Telephone | 920-216-3133
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N 18TH AVE STE 105
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City | MONROE
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State | WI
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Zip | 53566-1482
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Country | US
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Telephone | 608-325-7200
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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 | 3082-035
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License Number State | WI
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