Basic Information
| Provider Information | |||||||||
| NPI: | 1750375655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | MARY-JO | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | W8691 COUNTY ROAD U | ||||||||
| Address2: | |||||||||
| City: | GLENBEULAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530231700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205263747 | ||||||||
| FaxNumber: | 2626705044 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 THEIL ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530271448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622236014 | ||||||||
| FaxNumber: | 2626705044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2459 | WI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.