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General NPI Number Information
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NPI Number | 1518089341
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Entity Type | Individual
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Provider Name | KARL GREGORY SCHWANDT O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5497 S 76TH ST
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City | GREENDALE
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State | WI
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Zip | 53129-1130
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Country | US
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Telephone | 414-423-0293
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Fax |
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Provider Business Mailing Address
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Address Line | 11013 67TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-7548
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Country | US
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Telephone | 262-764-2023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2973-035
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | IL
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