MEDICARE: DR. CALLIE ENYART 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	2856	WI

General Provider Information

NPI Number	:	1730165861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALLIE ENYART O.D.

Provider Business Mailing Address
First Line	:	185 W NETHERWOOD RD
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-1100
Country	:	US
Telephone Number	:	608-835-3579
Fax Number	:	608-835-5828

Provider Business Practice Location Address
First Line	:	185 W NETHERWOOD RD
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-1100
Country	:	US
Telephone Number	:	608-835-3579
Fax Number	:	608-835-5828

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. CALLIE ENYART O.D.” Practice Location

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