Provider Demographics
NPI:1245231836
Name:HIGGINS, DONNA ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ANNE
Last Name:HIGGINS
Suffix:
Gender:F
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:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-0379
Mailing Address - Country:US
Mailing Address - Phone:608-326-6223
Mailing Address - Fax:
Practice Address - Street 1:117 W BLACKHAWK AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1422
Practice Address - Country:US
Practice Address - Phone:608-326-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1771035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38512800Medicaid
WI410020343OtherPALMETTO GBA - RAILROAD MEDICARE
IA0901207Medicaid
WI3913931450001OtherTRICARE
WI38512800Medicaid
WI0272140001Medicare NSC
WI000087405Medicare PIN