Organization
EYE CLINIC OF WAUKESHA LLC
Active
Other names
Kristopher Knous OD LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GENNI MAHONEY OPTICIAN (OWNER)
(262) 549-2020
Entity
Organization
Contact information
Practice address
2426 N GRANDVIEW BLVD, SUITE D, WAUKESHA, WI 53188-6905
(262) 549-2020
(262) 522-8117
Mailing address
2426 N GRANDVIEW BLVD, SUITE D, WAUKESHA, WI 53188-6905
(262) 549-2020
(262) 522-8117
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2999
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356432199
PERSONAL NPI
WI
05
—
38625000
—
WI
01
—
3946025
MEDICARE PROVIDER NUMBER
WI
Enumeration date
09/05/2008
Last updated
01/15/2010
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