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Individual

THERESA LYNN PETRICK GATCHELL

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
1300 S KOELLER ROAD, OSHKOSH, WI 54902
(920) 426-5730
(920) 426-1708
Mailing address
1300 S KOELLER ROAD, OSHKOSH, WI 54902
(920) 426-5730
(920) 426-1708

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2857-035
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38615900
WI
Enumeration date
05/22/2006
Last updated
07/08/2007
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