Provider Demographics
NPI:1619002243
Name:PRELL, JOE G (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:G
Last Name:PRELL
Suffix:
Gender:M
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 309
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-0309
Mailing Address - Country:US
Mailing Address - Phone:608-524-4334
Mailing Address - Fax:608-524-4335
Practice Address - Street 1:251 2ND ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1610
Practice Address - Country:US
Practice Address - Phone:608-524-4334
Practice Address - Fax:608-524-4335
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38506100Medicaid
WIT63030Medicare UPIN
WI38506100Medicaid
WI0915410001Medicare NSC