Individual
DR. ANNETTE J WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1255 APPLETON RD, MENASHA, WI 54952-1501
(920) 722-6872
(920) 722-6335
Mailing address
1255 APPLETON RD, MENASHA, WI 54952-1501
(920) 722-6872
(920) 722-6335
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2869-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38615000
—
WI
Enumeration date
08/29/2005
Last updated
05/08/2008
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