NPI 1003828740

Brad J Lavallie, OD

Practitioner Optometrist Green Bay, WI

Practice location

Address: 2253 W Mason St, Green Bay, WI 54303-4706
Phone: (920) 327-7000
Fax: (920) 327-7005
Mailing address: 1035 Kepler Dr, Green Bay, WI 54311-8320

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 2706 (WI)

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Registry record

NPI: 1003828740
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Aug 2006
Record last updated: 28 Apr 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.