Moen, Robert Marcus

Moen, Robert Marcus is an individual health care provider with primary practice located at 1710 S Main St , West Bend WI 53095-4938. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Moen, Robert Marcus can be contacted via phone (262) 334-7077.

Contact Information

Primary practice address
1710 S Main St West Bend WI 53095-4938
Phone: (262) 334-7077
Fax: (262) 338-3505
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1823 Wisconsin

Profile Details

NPI number 1871547612
LBN Legal business name Moen, Robert Marcus
Credentials O.D.O1/
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated Jul 9th, 2007 - about 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871547612 NPPES
Wisconsin MEDICAID 38577100

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