MEDICARE: KARRIE SESTAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT003526	GA

General Provider Information

NPI Number	:	1902597222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRIE SESTAK

Provider Business Mailing Address
First Line	:	1512 WALLACE ST
Second Line	:
City	:	SAINT PAUL
State	:	NE
Zip	:	68873-1008
Country	:	US
Telephone Number	:	308-750-3931
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 JOHNSON FY RD NE STE 130
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2130
Country	:	US
Telephone Number	:	404-953-4034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	08/09/2023

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Directions to “ KARRIE SESTAK ” Practice Location

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