Bradley J Wicklund, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3049-035 Issued in WI

Practice address

100 Carr Rd
Plymouth, WI 53073-9500

Phone

(920) 893-3937

Fax

(920) 892-8886

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

20-20 Visions LLCGroup PAC ID 0749275782, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 20-20 Visions LLC

  • Optometrist
  • Plymouth, WI
  • NPI 1821139932
  Medicare reassignment Care Compare group NPD
• Stein Optical Inc.

  • Optometrist
  • Milwaukee, WI
  • NPI 1801829551
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1366508293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CARR RD",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530739500",
            "telephone_number": "920-893-3937",
            "fax_number": "920-892-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CARR RD",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530739500",
            "telephone_number": "920-893-3937",
            "fax_number": "920-892-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLUND",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3049-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38630800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• WD Dental Implant
• Joseph Allen Weber, MD
• Sarah A Wegner, PT
• Joseph P White, DDS
• Corinne Beiersdorf Wicklund, OD
• Lynnett M Wilderman, PA-C
• Willowglen Academy-Wisconsin, Inc.
• Willowglen Hein Foster Care Group Home
• Lindsey Wolf, DPT

• Optometrist in Plymouth, WI
• Providers in Plymouth, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.