Provider Demographics
NPI:1659634848
Name:BUCKLEY, BRETT MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MICHAEL
Last Name:BUCKLEY
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 1:1816 FENWICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4418
Mailing Address - Country:US
Mailing Address - Phone:715-579-0576
Mailing Address - Fax:
Practice Address - Street 1:4800 GOLF RD STE 127
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9049
Practice Address - Country:US
Practice Address - Phone:715-834-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3549152W00000X
WI3273-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI020677066OtherVISIONWORKS