Provider Demographics
NPI:1760225056
Name:PRENOT, DERRICK GENE (OD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:GENE
Last Name:PRENOT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17 SHERMAN TER UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4440
Mailing Address - Country:US
Mailing Address - Phone:507-313-2001
Mailing Address - Fax:
Practice Address - Street 1:2150 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5507
Practice Address - Country:US
Practice Address - Phone:608-824-3963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4010-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist