Lavallie, Brad J
Lavallie, Brad J is an individual health care provider with primary practice located at 2253 W Mason St , Green Bay WI 54303-4706. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Lavallie, Brad J can be contacted via phone (920) 327-7000.Contact Information
Primary practice address
2253 W Mason St
Green Bay WI 54303-4706
Phone: (920) 327-7000
Fax: (920) 327-7005
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2706 | Wisconsin |
Profile Details
| NPI number | 1003828740 |
|---|---|
| LBN Legal business name | Lavallie, Brad J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 12th, 2006 |
| Last updated | Apr 9th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003828740 | NPPES |
| Wisconsin | MEDICAID | 38627900 |
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