Provider Demographics
NPI:1013060136
Name:DLOUHY, DONALD E (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:DLOUHY
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 1:12728 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-1602
Mailing Address - Country:US
Mailing Address - Phone:262-781-8693
Mailing Address - Fax:262-781-1468
Practice Address - Street 1:12728 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1602
Practice Address - Country:US
Practice Address - Phone:262-781-8693
Practice Address - Fax:262-781-1468
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1863-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391466974OtherEYEMED
WI915497OtherVIPA
WIDE41133OtherSPECTERA
WI391466974OtherNVA
WI028578001OtherNATIONAL SUPPLIER
WI38519900Medicaid
WI391466974OtherVCP
WI391466974OtherVSP
WI391466974OtherVCP
WI391466974OtherVCP
WI391466974OtherEYEMED