Brad J Lavallie
Optometrist
2253 W Mason St Ste 100
Green Bay
, Wisconsin 54303-4706
Brad J Lavallie
Optometrist
2253 W Mason St Ste 100
Green Bay
, Wisconsin 54303-4706
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About
Features
Specialties
- Optometrist
Languages spoken
- English
Location
First Address
- Brad J Lavallie
- 164 N Broadway
- Green Bay, WI
- Zip : 54303-2728
- Phone :
Second Address
- Brad J Lavallie
- 2253 W Mason St Ste 100
- Green Bay, WI
- Zip : 54303-4706
- Fax : (920) 327-7005
- Phone : (920) 327-7000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2706 | WI |
National Provider Identifier
| NPI | 1003828740 |
|---|---|
| Provider Name | Brad J Lavallie |
| First Address | Green Bay, WI 54303-2728 |
| Second Address | Green Bay, WI 54303-4706 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/08/2006 |
| Last Update Date | 13/03/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 38627900 | (05) | WI |
| U78458 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.