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NPI Code Detail

MEDICARE: RENEE LYNN WALDEN OD

MEDICARE: RENEE LYNN WALDEN OD
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
1152W00000XOptometrist1482DTKY
2152W00000XOptometrist3068-035WI

Other Identifiers

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

General Provider Information

NPI Number : 1437141579
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE LYNN WALDEN OD
Provider Business Mailing Address
First Line : 9188 GOLF VIEW DR
Second Line :
City : MINOCQUA
State : WI
Zip : 54548-9268
Country : US
Telephone Number : 715-358-1978
Fax Number :
Provider Business Practice Location Address
First Line : 8201 MISH KO SWEN DR
Second Line :
City : CRANDON
State : WI
Zip : 54520-8631
Country : US
Telephone Number : 715-478-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 04/13/2015

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Directions to “ RENEE LYNN WALDEN OD” Practice Location

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