Individual
BRADLEY J JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1225 W NORTHLAND AVE, APPLETON, WI 54914-1416
(920) 731-2020
Mailing address
1225 W NORTHLAND AVE, APPLETON, WI 54914-1416
(920) 731-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2008
WI
Other
Enumeration date
02/21/2006
Last updated
08/16/2011
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