Provider Demographics
NPI:1063859130
Name:OSTRANDER, MIKEAL ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:MIKEAL
Middle Name:ROBERT
Last Name:OSTRANDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N901 COUNTY HIGHWAY MD
Mailing Address - Street 2:
Mailing Address - City:SARONA
Mailing Address - State:WI
Mailing Address - Zip Code:54870-9259
Mailing Address - Country:US
Mailing Address - Phone:715-651-1944
Mailing Address - Fax:
Practice Address - Street 1:15569 RAILROAD ST STE 301
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5707
Practice Address - Country:US
Practice Address - Phone:715-236-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3296-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3296-35OtherWISCONSIN OPTOMETRY EXAMINING BOARD