Individual
DR. TODD WILLIAM WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
415 E ANN ST, WEYAUWEGA, WI 54983-8532
(920) 867-3131
(920) 867-3408
Mailing address
PO BOX 350, WEYAUWEGA, WI 54983-0350
(920) 867-3131
(920) 867-3408
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2346
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38578700
—
WI
Enumeration date
07/06/2006
Last updated
11/30/2021
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