Provider Demographics
NPI:1639481534
Name:SPRINGSTROH, CORY A (OD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:A
Last Name:SPRINGSTROH
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 1:240 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3115
Mailing Address - Country:US
Mailing Address - Phone:920-887-1151
Mailing Address - Fax:920-887-3353
Practice Address - Street 1:240 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3115
Practice Address - Country:US
Practice Address - Phone:920-887-1151
Practice Address - Fax:920-887-3353
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3183-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3183-35OtherSTATE LICENSE