Provider Demographics
NPI:1548262033
Name:NEITZKE, MARCUS J (OD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:J
Last Name:NEITZKE
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 1:3228 TURNBERRY OAK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3969
Mailing Address - Country:US
Mailing Address - Phone:262-542-7113
Mailing Address - Fax:262-542-9439
Practice Address - Street 1:3228 TURNBERRY OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3969
Practice Address - Country:US
Practice Address - Phone:262-542-7113
Practice Address - Fax:262-542-9439
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38608500Medicaid
WIP00327818OtherPALMETTO GBA-RAILROAD MEDICARE
WIP00327818OtherPALMETTO GBA-RAILROAD MEDICARE
WI38608500Medicaid