Wild, Randy Joseph
Wild, Randy Joseph is an sole proprietor health care provider with primary practice located at 1111 Maple St , Neenah WI 54956-4122. He recently has 6 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Pediatrics, Eye and Vision Services Providers / Sports Vision, Eye and Vision Services Providers / Vision Therapy, Eye and Vision Services Providers / Occupational Vision. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Wild, Randy Joseph can be contacted via phone (920) 722-7411.Contact Information
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Optometrist | 152W00000X | 1706 | Wisconsin |
Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 1706 | Wisconsin |
Eye and Vision Services Providers / Pediatrics | 152WP0200X | 1706 | Wisconsin |
Eye and Vision Services Providers / Sports Vision | 152WS0006X | 1706 | Wisconsin |
Eye and Vision Services Providers / Vision Therapy | 152WV0400X | 1706 | Wisconsin |
Eye and Vision Services Providers / Occupational Vision | 152WX0102X | 1706 | Wisconsin |
Profile Details
NPI number | 1891812749 |
---|---|
LBN Legal business name | Wild, Randy Joseph |
Credentials | Doctor of Optometry (OD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Mar 24th, 2007 |
Last updated | Jun 6th, 2008 - about 17 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 | 1891812749 | NPPES |
Wisconsin | MEDICAID | 38509100 |
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