Provider Demographics
NPI:1114137452
Name:JAREMCZUK, WILHELM (OD)
Entity Type:Individual
Prefix:DR
First Name:WILHELM
Middle Name:
Last Name:JAREMCZUK
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 1:11 N WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3312
Mailing Address - Country:US
Mailing Address - Phone:802-862-3223
Mailing Address - Fax:802-862-1763
Practice Address - Street 1:11 N WILLARD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3312
Practice Address - Country:US
Practice Address - Phone:802-862-3223
Practice Address - Fax:802-862-1763
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT30000183152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist