Provider Demographics
NPI:1922077106
Name:NOVAK, ANTHONY FRANK (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANK
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 E POMEROY ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-3506
Mailing Address - Country:US
Mailing Address - Phone:715-425-0115
Mailing Address - Fax:715-425-6001
Practice Address - Street 1:183 E POMEROY ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3506
Practice Address - Country:US
Practice Address - Phone:715-425-0115
Practice Address - Fax:715-425-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30164207W00000X
WI30071-20207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31500600Medicaid
MN180001287Medicare PIN
WI31500600Medicaid