Individual
DR. MARK A DAGENAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3670 S 108TH ST STE 204, MILWAUKEE, WI 53228-1237
(414) 453-1010
(414) 425-4230
Mailing address
3670 S 108TH ST STE 204, MILWAUKEE, WI 53228-1237
(414) 453-1010
(262) 542-9439
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2704
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38603400
—
WI
Enumeration date
08/10/2005
Last updated
08/16/2024
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