Healthcare Provider Details

I. General information

NPI: 1134440670
Provider Name (Legal Business Name): WILLIAM JOSEPH REYNDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 W MASON ST
GREEN BAY WI
54303
US

IV. Provider business mailing address

1035 KEPLER DR
GREEN BAY WI
54311-8320
US

V. Phone/Fax

Practice location:
  • Phone: 920-327-7000
  • Fax: 920-327-7005
Mailing address:
  • Phone: 920-490-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number56158-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: