Provider Demographics
NPI:1548302847
Name:SATEREN, CORWIN JAMES (OD)
Entity type:Individual
Prefix:
First Name:CORWIN
Middle Name:JAMES
Last Name:SATEREN
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 1:218 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1606
Mailing Address - Country:US
Mailing Address - Phone:715-682-4666
Mailing Address - Fax:715-682-4984
Practice Address - Street 1:218 MAIN ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1606
Practice Address - Country:US
Practice Address - Phone:715-682-4666
Practice Address - Fax:715-682-4984
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38593500Medicaid
WI30125OtherAVESIS GROUP NUMBER
WI94131015038OtherPREFERRED ONE
WI17G75SAMedicaid
WI22-00509OtherMEDICA
WIU16702OtherMAIL HANDLERS BENEFIT
WI01-015038OtherWAICU PREFERRED ONE
WI17G75SAOtherBCBS MI AND SELECT
WI1114040001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT
WI30125OtherAVESIS GROUP NUMBER