Healthcare Provider Details

I. General information

NPI: 1346169604
Provider Name (Legal Business Name): ROSEMBRANDT GONZALEZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4784 W INTEGRITY WAY
APPLETON WI
54913-8464
US

IV. Provider business mailing address

4152 N LIGHTNING DR APT 11
APPLETON WI
54913-6751
US

V. Phone/Fax

Practice location:
  • Phone: 920-636-4070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4155-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: