Provider Demographics
NPI:1861013567
Name:WOLFE, BRITTANY NICHOLE (OD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICHOLE
Last Name:WOLFE
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 1:5707 W MAPLE GROVE RD APT 3024
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8914
Mailing Address - Country:US
Mailing Address - Phone:765-667-3189
Mailing Address - Fax:
Practice Address - Street 1:2500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2011
Practice Address - Country:US
Practice Address - Phone:574-722-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004218A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist