Healthcare Provider Details

I. General information

NPI: 1275640385
Provider Name (Legal Business Name): AMY C TREICHEL BRANDT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N WESTHAVEN DR
OSHKOSH WI
54904
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-456-2000
  • Fax: 920-456-2001
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2524-035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: