Provider Demographics
NPI:1174511109
Name:SCHUETTE, WALLY R (OD)
Entity Type:Individual
Prefix:DR
First Name:WALLY
Middle Name:R
Last Name:SCHUETTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:211 2ND ST
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-0066
Mailing Address - Country:US
Mailing Address - Phone:715-386-2020
Mailing Address - Fax:715-386-1600
Practice Address - Street 1:211 2ND ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1505
Practice Address - Country:US
Practice Address - Phone:715-386-2020
Practice Address - Fax:715-386-1600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1487 035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38543700Medicaid
MS0095198OtherDEA
WI38543700Medicaid
MS0095198OtherDEA