Provider Demographics
NPI:1811568850
Name:SIGMUND, COLIN JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JAMES
Last Name:SIGMUND
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 1:115 E WALNUT ST APT 710
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4226
Mailing Address - Country:US
Mailing Address - Phone:920-639-5447
Mailing Address - Fax:
Practice Address - Street 1:1543 PARK PL STE 400
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1970
Practice Address - Country:US
Practice Address - Phone:920-497-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist