Provider Demographics
NPI:1568535722
Name:BUFFINGTON, KATHLEEN ERIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ERIN
Last Name:BUFFINGTON
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 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2768-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38615300Medicaid
WIMB0441941OtherDEA
WI000047263Medicare ID - Type Unspecified
WI38615300Medicaid
WI4880340001Medicare NSC