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General NPI Number Information
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NPI Number | 1902103369
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Entity Type | Organization
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Legal Business Name | JOHN W THORPE OPTOMETRISTS SC
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 14145 W GREENFIELD AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-1640
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Country | US
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Telephone | 262-784-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 14145 W GREENFIELD AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 262-784-6446
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JOHN W THORPE
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Credential | O.D.
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Telephone | 262-784-6446
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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 | WI1362
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License Number State | WI
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