Provider Demographics
NPI:1639332935
Name:BIGARI, KATIE TERESE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:TERESE
Last Name:BIGARI
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 1:1334 NTH 4TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487
Mailing Address - Country:US
Mailing Address - Phone:715-224-2200
Mailing Address - Fax:419-858-9769
Practice Address - Street 1:1334 N 4TH ST
Practice Address - Street 2:STE 101
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2137
Practice Address - Country:US
Practice Address - Phone:715-224-2200
Practice Address - Fax:419-858-9769
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002425152W00000X
MI4901004478152W00000X
WI3166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist