Provider Demographics
NPI:1467696526
Name:GOETSCH, JEREMY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:GOETSCH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:408 N 3RD ST
Mailing Address - Street 2:STE 305
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5455
Mailing Address - Country:US
Mailing Address - Phone:608-239-1218
Mailing Address - Fax:715-803-4010
Practice Address - Street 1:412 3RD ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1425
Practice Address - Country:US
Practice Address - Phone:715-693-2400
Practice Address - Fax:715-693-4699
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3146-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist