Provider Demographics
NPI:1932388394
Name:GERMAIN, JILL MARIE (OD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:GERMAIN
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 1:2101 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1638
Mailing Address - Country:US
Mailing Address - Phone:715-965-6748
Mailing Address - Fax:
Practice Address - Street 1:2101 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1638
Practice Address - Country:US
Practice Address - Phone:715-965-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3095-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist