Provider Demographics
NPI:1073726576
Name:DELAKIS, PAUL S (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:DELAKIS
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 1:4054 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-9000
Mailing Address - Country:US
Mailing Address - Phone:715-833-1220
Mailing Address - Fax:715-833-1297
Practice Address - Street 1:4054 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9000
Practice Address - Country:US
Practice Address - Phone:715-833-1220
Practice Address - Fax:715-833-1297
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2275-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2275035OtherOPTOMETRIST TPA
WI38580900Medicaid
WI38580900Medicaid
WIU78148Medicare UPIN