Provider Demographics
NPI:1962477240
Name:LAEYENDECKER, FRANCIE (OD)
Entity Type:Individual
Prefix:
First Name:FRANCIE
Middle Name:
Last Name:LAEYENDECKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W NORTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1416
Mailing Address - Country:US
Mailing Address - Phone:920-731-2020
Mailing Address - Fax:
Practice Address - Street 1:1225 W NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1416
Practice Address - Country:US
Practice Address - Phone:920-731-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI003247260Medicare PIN
WIU51131Medicare UPIN