Wilde, Annette J

Wilde, Annette J is an individual health care provider with primary practice located at 1255 Appleton Rd , Menasha WI 54952-1501. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Wilde, Annette J can be contacted via phone (920) 722-6872.

Contact Information

Primary practice address
1255 Appleton Rd Menasha WI 54952-1501
Fax: (920) 722-6335
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2869-035 Wisconsin

Profile Details

NPI number 1205829942
LBN Legal business name Wilde, Annette J
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2005
Last updated May 8th, 2008 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205829942 NPPES
Wisconsin MEDICAID 38615000

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