Provider Demographics
NPI:1437472701
Name:BUFFINGTON OPTOMETRY LLC
Entity Type:Organization
Organization Name:BUFFINGTON OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-358-4060
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-0740
Mailing Address - Country:US
Mailing Address - Phone:715-358-4060
Mailing Address - Fax:715-358-2561
Practice Address - Street 1:706 ELM ST.
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-0740
Practice Address - Country:US
Practice Address - Phone:715-358-4060
Practice Address - Fax:715-358-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2768-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty