MEDICARE: DR. JAMES KENT DEGENER 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	1462	WI

General Provider Information

NPI Number	:	1447355227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES KENT DEGENER O.D.

Provider Business Mailing Address
First Line	:	20908 COUNTY HIGHWAY T
Second Line	:
City	:	NORWALK
State	:	WI
Zip	:	54648-8016
Country	:	US
Telephone Number	:	608-343-0926
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 HIGHWAY 12
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913
Country	:	US
Telephone Number	:	608-356-6276
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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