Vandriel, Busisiwe Rose

Vandriel, Busisiwe Rose is an individual health care provider with primary practice located at 200 S 18Th Ave , Wausau WI 54401-4252. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Vandriel, Busisiwe Rose can be contacted via phone (715) 842-8040.

Contact Information

Primary practice address
200 S 18Th Ave Wausau WI 54401-4252
Phone: (715) 842-8040
Fax: (715) 848-8773
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 3085-035 Wisconsin
Eye and Vision Services Providers / Optometrist 152W00000X 3081 Minnesota
Eye and Vision Services Providers / Optometrist 152W00000X 00004168 Washington

Profile Details

NPI number 1043403967
LBN Legal business name Vandriel, Busisiwe Rose
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2007
Last updated Jul 29th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043403967 NPPES
Wisconsin MEDICAID 38632500

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