Individual
CORINNE BEIERSDORF WICKLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
100 CARR RD, PLYMOUTH, WI 53073-9500
(920) 892-3937
(920) 892-6668
Mailing address
PO BOX 600, PLYMOUTH, WI 53073-0600
(920) 893-3937
(920) 892-6668
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3046-035
WI
152WL0500X
Low Vision Rehabilitation Optometrist
3046-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3046-035
STATE LICENSE NUMBER
WI
Enumeration date
07/20/2006
Last updated
09/25/2025
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