Individual
DR. RANDY JOSEPH WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1111 MAPLE ST, NEENAH, WI 54956-4122
(920) 722-7411
Mailing address
1111 MAPLE ST, NEENAH, WI 54956-4122
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1706
WI
152WC0802X
Corneal and Contact Management Optometrist
1706
WI
152WP0200X
Pediatric Optometrist
1706
WI
152WS0006X
Sports Vision Optometrist
1706
WI
152WV0400X
Vision Therapy Optometrist
1706
WI
152WX0102X
Occupational Vision Optometrist
1706
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38509100
—
WI
Enumeration date
03/24/2007
Last updated
06/06/2008
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