Most Relevant Information
Provider Data
| NPI Number: | 1003828740 |
| Provider Name: | BRAD J LAVALLIE OD |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | 2706 |
Most Important Dates
| Enumeration Date: | 08/12/2006 |
| Last Updated: | 04/09/2024 |
Provider Practice Location
2253 W MASON ST
GREEN BAY
WI
543034706
Practice Location Phone/Fax
| Phone: | 9203277000 |
| Fax: | 9203277005 |
Provider Mailing Location
1035 KEPLER DR
GREEN BAY
WI
543118320
Provider Mailing Phone/Fax
| Phone: | 9204909046 |
| Fax: |