Healthcare Provider Details

I. General information

NPI: 1669056974
Provider Name (Legal Business Name): JESSICA BRAUNEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 3RD ST
MOSINEE WI
54455-1425
US

IV. Provider business mailing address

408 N 3RD ST STE 402
WAUSAU WI
54403-5455
US

V. Phone/Fax

Practice location:
  • Phone: 715-693-2400
  • Fax: 715-693-4699
Mailing address:
  • Phone: 715-298-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3672-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: