BRAD J LAVALLIE (NPI# 1003828740) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003828740 |
| Entity Type | Individual |
| Full Name | BRAD J LAVALLIE |
| Credential | OD |
| Practice Address |
2253 W Mason St Ste 100 Green Bay WI 54303-4706 |
| Mailing Address |
164 N Broadway Green Bay WI 54303-2728 |
| Practice Telephone | 9203277000 |
| Practice Fax Number | 9203277005 |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2017-03-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2706 | WI | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 38627900 | 05 |
| Street Address |
2253 W MASON ST STE 100 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-4706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790720100 | Dianna L Bordewick | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-19 |
| 1497220107 | Linda Thieme | Technician/Technologist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2018-10-09 |
| 1306075635 | Jacob A Kozisek | Optometrist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2009-07-08 |
| 1265623649 | Joseph Thomas Bergmann | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2007-08-09 |
| 1932218005 | Wei-chuan Wang | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-08-30 |
| 1144241852 | Kevin P Wienkers | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-21 |
| 1558381632 | Brian T Perkovich | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-20 |
| 1790702652 | Kirk D Scattergood | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-16 |
| 1235167537 | Mark T Duffy | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-28 |
| 1568490829 | William J Foster | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861054314 | Myeyedr Optometry of Wisconsin, LLC | Optometrist | 535 S Monroe Ave, Green Bay, WI 54301-4017 | 2019-07-05 |
| 1588177539 | Voss Eyecare Sc | Optometrist | 605 S Military Ave, Green Bay, WI 54303-2211 | 2017-11-13 |
| 1922440429 | Jessica Hilbert | Optometrist | 2461 Holmgren Way, Green Bay, WI 54304-5224 | 2013-07-24 |
| 1780971499 | Craig Alan Keller | Optometrist | 301 Bay Park Square, Green Bay, WI 54304-5104 | 2011-07-01 |
| 1902104946 | Howard Vision Clinic Inc | Optometrist | 2149 Velp Ave Ste 100, Green Bay, WI 54303-5424 | 2011-02-28 |
| 1275845414 | Michelle Schleis | Optometrist | 2851 University Ave, Green Bay, WI 54311-5855 | 2010-07-03 |
| 1336322502 | T.j. Pease & Associates, S.c. | Optometrist | 2324 University Ave, Green Bay, WI 54302-4536 | 2007-12-11 |
| 1447441779 | Muller Eyecare Associates Ltd | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-08-01 |
| 1699974980 | Eye Associates of Green Bay, Sc | Optometrist | 2020 Riverside Dr Ste 201, Green Bay, WI 54301-2300 | 2007-07-16 |
| 1508903766 | Randall J Paye | Optometrist | 1515 6th St, Green Bay, WI 54304-2272 | 2007-01-30 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.