Johanknecht, David Earl
Johanknecht, David Earl is an individual health care provider with primary practice located at 269 Memorial Dr Suite 103, Berlin WI 54923. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Johanknecht, David Earl can be contacted via phone (920) 361-1696.Contact Information
Primary practice address
269 Memorial Dr Suite 103
Berlin WI 54923
Phone: (920) 361-1696
Fax: (920) 361-1247
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1404-035 | Wisconsin |
Profile Details
| NPI number | 1114078243 |
|---|---|
| LBN Legal business name | Johanknecht, David Earl |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 16th, 2007 |
| Last updated | Jul 8th, 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 | 1114078243 | NPPES |
| Wisconsin | MEDICAID | 38563200 |
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