Provider Demographics
NPI:1043652720
Name:BUCHHOLZ, KATIE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:695 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4922
Mailing Address - Country:US
Mailing Address - Phone:414-961-6000
Mailing Address - Fax:847-832-9691
Practice Address - Street 1:4801 EXPO DR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-9341
Practice Address - Country:US
Practice Address - Phone:920-684-4429
Practice Address - Fax:920-684-6892
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3315-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist