Provider Demographics
NPI:1932153061
Name:BACHMAN GROTH, JANE A (OD)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:BACHMAN GROTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:A
Other - Last Name:BACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:925 N 87TH ST
Mailing Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4812
Mailing Address - Country:US
Mailing Address - Phone:414-456-2020
Mailing Address - Fax:414-456-6300
Practice Address - Street 1:925 N 87TH ST
Practice Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4812
Practice Address - Country:US
Practice Address - Phone:414-456-2020
Practice Address - Fax:414-456-6300
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
005000261UOtherHUMANA
WI38617600Medicaid
WI1932153061Medicaid
005000261UOtherHUMANA
U40108Medicare UPIN