Provider Demographics
NPI:1053487124
Name:HEALY, JAMES L (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:HEALY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 17TH AVE
Mailing Address - Street 2:P.O. BOX 299
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-2063
Mailing Address - Country:US
Mailing Address - Phone:608-325-5606
Mailing Address - Fax:608-325-5637
Practice Address - Street 1:1113 17TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-2063
Practice Address - Country:US
Practice Address - Phone:608-325-5606
Practice Address - Fax:608-325-5637
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1670152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62159Medicare UPIN
WI42055 0001Medicare ID - Type Unspecified