Provider Demographics
NPI:1730165861
Name:ENYART, CALLIE (OD)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:
Last Name:ENYART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W NETHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1100
Mailing Address - Country:US
Mailing Address - Phone:608-835-3579
Mailing Address - Fax:608-835-5828
Practice Address - Street 1:185 W NETHERWOOD RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1100
Practice Address - Country:US
Practice Address - Phone:608-835-3579
Practice Address - Fax:608-835-5828
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU85482Medicare UPIN