Individual
DR. MARY ELLEN TECLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
17495 W CAPITOL DR, SUITE D, BROOKFIELD, WI 53045-2059
(262) 797-9638
Mailing address
503 COMMERCE DR, MADISON, WI 53719-4941
(608) 833-0062
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3440-35
WI
Other
Enumeration date
11/21/2016
Last updated
08/06/2018
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