Individual
LANCE ENGDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7425 W. APPLETON AVENUE, MILWAUKEE, WI 53216
(414) 464-5440
(414) 464-0996
Mailing address
11103 WEST AVE, SUITE 6, SAN ANTONIO, TX 78213-1370
(210) 524-6663
(210) 524-6587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2711-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38616700
—
WI
Enumeration date
12/28/2006
Last updated
10/28/2011
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