Individual
DR. TIMOTHY J FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
15569 RAILROAD ST, STE 301, HAYWARD, WI 54843-5707
(715) 634-8616
Mailing address
1200 PARK CREEK CT, FALL CREEK, WI 54742-5316
(715) 271-9899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2235-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38577900
—
WI
Enumeration date
08/18/2005
Last updated
01/09/2020
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