Individual
DR. BRYCE ALEXANDRA LEWELLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 793-7515
(920) 793-7516
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3647
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106622
—
WI
Enumeration date
07/01/2016
Last updated
10/02/2023
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