Individual
PRANAYA BISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10996 N PORT WASHINGTON RD, MEQUON, WI 53092-5031
(262) 240-9870
Mailing address
13660 W WILDFLOWER LN, NEW BERLIN, WI 53151-7556
(414) 241-4611
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3694-35
WI
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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