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General NPI Number Information
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NPI Number | 1861492126
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Entity Type | Individual
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Provider Name | JESSICA L ENTRINGER DO
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 1442 N 31ST ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3061
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Country | US
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Telephone | 920-452-1810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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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 | 2762-035
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License Number State | WI
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