Individual
DR. BRADLEY J WICKLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
100 CARR RD, PLYMOUTH, WI 53073-9500
(920) 893-3937
(920) 892-8886
Mailing address
100 CARR RD, PLYMOUTH, WI 53073-9500
(920) 893-3937
(920) 892-8886
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3049-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38630800
—
WI
Enumeration date
12/28/2006
Last updated
07/15/2014
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