Individual
ANDREA C SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1025 REGENT ST, MADISON, WI 53715-1248
(608) 282-2000
(608) 282-2172
Mailing address
1025 REGENT ST, MADISON, WI 53715-1248
(608) 282-2000
(608) 282-2172
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
14890
CA
152W00000X
Optometrist
3316-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831531557
—
WI
Enumeration date
07/23/2013
Last updated
02/25/2019
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