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General NPI Number Information
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NPI Number | 1356622898
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Entity Type | Organization
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Legal Business Name | PRN EYE ASSOCIATES LLC
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 950 PORT WASHINGTON RD
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City | GRAFTON
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State | WI
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Zip | 53024-9201
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Country | US
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Telephone | 262-204-1063
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Fax |
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Provider Business Mailing Address
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Address Line | 935 N GRANT ST
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1459
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Country | US
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Telephone | 262-352-7932
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTOPHER T KNOUS
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Credential | O.D.
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Telephone | 262-352-7932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2999
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License Number State | WI
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