Individual
BUSISIWE ROSE VANDRIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
200 S 18TH AVE, WAUSAU, WI 54401-4252
(715) 842-8040
(715) 848-8773
Mailing address
200 S 18TH AVE, WAUSAU, WI 54401-4252
(715) 842-8040
(715) 848-8773
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
00004168
WA
152W00000X
Optometrist
3081
MN
152W00000X
Optometrist
Primary
3085-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38632500
—
WI
Enumeration date
08/23/2007
Last updated
07/29/2014
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