Individual
DR. MARC FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1800 PLOVER RD, PLOVER, WI 54467-3978
(715) 342-9634
(715) 342-9244
Mailing address
2641 GOLDEN RD, PLOVER, WI 54467-2576
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2769-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38607300
—
WI
Enumeration date
05/15/2006
Last updated
07/09/2007
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