Wicklund, Bradley J
Wicklund, Bradley J is an individual health care provider with primary practice located at 100 Carr Rd , Plymouth WI 53073-9500. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wicklund, Bradley J can be contacted via phone (920) 893-3937.Contact Information
Primary practice address
100 Carr Rd
Plymouth WI 53073-9500
Phone: (920) 893-3937
Fax: (920) 892-8886
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 3049-035 | Wisconsin |
Profile Details
| NPI number | 1366508293 |
|---|---|
| LBN Legal business name | Wicklund, Bradley J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 28th, 2006 |
| Last updated | Jul 15th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366508293 | NPPES |
| Wisconsin | MEDICAID | 38630800 |
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