MEDICARE: DR. PAUL J GUENVEUR 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
1	152W00000X	Optometrist	1870	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	:	1740278290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J GUENVEUR OD

Provider Business Mailing Address
First Line	:	2300 N MAYFAIR RD
Second Line	:	#1155
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1505
Country	:	US
Telephone Number	:	414-258-6880
Fax Number	:	414-258-5686

Provider Business Practice Location Address
First Line	:	3631 W OKLAHOMA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4119
Country	:	US
Telephone Number	:	414-645-0344
Fax Number	:	414-645-6475

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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