Physician Compare National (NPI:1992737704)

HEALTHCARE PROVIDER: TODD WILLIAM WILD OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1992737704
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486704442
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090612000223
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILD
	Individual professional last name
Provider First Name	TODD
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	415 E ANN ST
	Group Practice or individual's line 1 address
City	WEYAUWEGA
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	549830350
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9208673131
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y