MEDICARE: SARAH KAYALI OD

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	4096-35	WI

General Provider Information

NPI Number	:	1104709153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KAYALI OD

Provider Business Mailing Address
First Line	:	12325 W BURLEIGH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-3116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12325 W BURLEIGH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-3116
Country	:	US
Telephone Number	:	414-873-9090
Fax Number	:

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

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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