Provider Demographics
NPI:1871539619
Name:DUSENBERRY, JAMES FREDERICK (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:DUSENBERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 WENZEL CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-2218
Mailing Address - Country:US
Mailing Address - Phone:920-988-0431
Mailing Address - Fax:
Practice Address - Street 1:825 W MORELAND BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2963
Practice Address - Country:US
Practice Address - Phone:262-542-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2804-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU82028Medicare UPIN