Individual
JACK LUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
459 W JOHNSON ST, FOND DU LAC, WI 54935-3161
(920) 922-5990
Mailing address
16800 W CLEVELAND AVE, NEW BERLIN, WI 53151-3533
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3912-35
WI
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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