Provider Demographics
NPI:1619669942
Name:SANGERMANO, ADAM JOSEPH (ABOC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:SANGERMANO
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1625 E SUNSET DR APT 108
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8215
Mailing Address - Country:US
Mailing Address - Phone:262-399-1998
Mailing Address - Fax:262-695-3806
Practice Address - Street 1:411 PEWAUKEE RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5886
Practice Address - Country:US
Practice Address - Phone:262-695-3191
Practice Address - Fax:262-695-3806
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI236760156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician