Provider Demographics
NPI:1487662177
Name:WEBB, DANA A (OD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:WEBB
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:N72W13400 LUND LN STE E
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4678
Mailing Address - Country:US
Mailing Address - Phone:262-208-1344
Mailing Address - Fax:262-509-0804
Practice Address - Street 1:N72W13400 LUND LN
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4678
Practice Address - Country:US
Practice Address - Phone:262-208-1344
Practice Address - Fax:262-509-0804
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2702-35152W00000X
WI2702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38610500Medicaid
WIP00477559OtherRR MEDICARE
WIU62733Medicare UPIN
WIP00477559OtherRR MEDICARE
WI38610500Medicaid