MEDICARE: DR. JOHN ERIC PAULSEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1895	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215921234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ERIC PAULSEN O.D.

Provider Business Mailing Address
First Line	:	165 N 3RD AVE
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-2415
Country	:	US
Telephone Number	:	920-743-2020
Fax Number	:	920-743-9601

Provider Business Practice Location Address
First Line	:	165 N 3RD AVE
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-2415
Country	:	US
Telephone Number	:	920-743-2020
Fax Number	:	920-743-9601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/14/2014

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