Individual
NICHOLE M. CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
675 WOLF RD, RANDOM LAKE, WI 53075-1264
(920) 994-8500
(920) 994-8550
Mailing address
675 WOLF RD, P.O.BOX 2, RANDOM LAKE, WI 53075-1264
(920) 994-8500
(920) 994-8550
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2823-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38623000
—
WI
Enumeration date
08/30/2006
Last updated
05/19/2014
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