Provider Demographics
NPI:1548445042
Name:KOLAR OPTOMETRIC, LLC
Entity type:Organization
Organization Name:KOLAR OPTOMETRIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-884-2030
Mailing Address - Street 1:8243 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-9527
Mailing Address - Country:US
Mailing Address - Phone:715-884-2030
Mailing Address - Fax:715-884-2509
Practice Address - Street 1:8243 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9527
Practice Address - Country:US
Practice Address - Phone:715-884-2030
Practice Address - Fax:715-884-2509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOLAR OPTOMETRIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-02
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU76875Medicare UPIN
WI1311030002Medicare NSC
WI47206Medicare PIN