Individual
BRAD J LAVALLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7000
(920) 327-7005
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
(920) 405-8005
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2706
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38627900
—
WI
Enumeration date
08/12/2006
Last updated
04/28/2026
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