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NPI Code Detail

MEDICARE: DR. YANNA T KISALA O.D.

MEDICARE: DR. YANNA T KISALA O.D.
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
1152W00000XOptometrist3137-035WI

General Provider Information

NPI Number : 1013164292
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YANNA T KISALA O.D.
Provider Business Mailing Address
First Line : 203A E SUNSET DR
Second Line :
City : WAUKESHA
State : WI
Zip : 53189-7603
Country : US
Telephone Number : 262-524-1130
Fax Number :
Provider Business Practice Location Address
First Line : 203A E SUNSET DR
Second Line :
City : WAUKESHA
State : WI
Zip : 53189-7603
Country : US
Telephone Number : 262-524-1130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 07/13/2020

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