Healthcare Provider Details

I. General information

NPI: 1215910880
Provider Name (Legal Business Name): AMY H PIKO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 94TH AVE
PLEASANT PRAIRIE WI
53158-1955
US

IV. Provider business mailing address

7707 94TH AVE
PLEASANT PRAIRIE WI
53158-1955
US

V. Phone/Fax

Practice location:
  • Phone: 262-597-1040
  • Fax: 262-597-1041
Mailing address:
  • Phone: 262-597-1040
  • Fax: 262-597-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-009771
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3369-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: