Provider Demographics
NPI:1619604972
Name:BOENTE, BRYCE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:BOENTE
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 1:1632 N FRANKLIN PL APT 411
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3771
Mailing Address - Country:US
Mailing Address - Phone:217-710-2933
Mailing Address - Fax:
Practice Address - Street 1:1166 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8441
Practice Address - Country:US
Practice Address - Phone:262-574-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3804-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist