Bloomquist, Nicole
Bloomquist, Nicole is an individual health care provider with primary practice located at 7214 Green Bay Rd , Kenosha WI 53142-3516. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Bloomquist, Nicole can be contacted via phone (262) 694-5464.Contact Information
Primary practice address
7214 Green Bay Rd
Kenosha WI 53142-3516
Phone: (262) 694-5464
Fax: (262) 694-5790
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2846-035 | Wisconsin |
Profile Details
| NPI number | 1427113430 |
|---|---|
| LBN Legal business name | Bloomquist, Nicole |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 27th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427113430 | NPPES |
| Wisconsin | MEDICAID | 38615100 |
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