MEDICARE: CARMEN M ALFONSO-KNEIERT 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	2485-035	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710938634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN M ALFONSO-KNEIERT OD

Provider Business Mailing Address
First Line	:	740 REENA AVE
Second Line	:	SUITE B
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-3145
Country	:	US
Telephone Number	:	920-563-8468
Fax Number	:	920-563-0178

Provider Business Practice Location Address
First Line	:	740 REENA AVE
Second Line	:	SUITE B
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-3145
Country	:	US
Telephone Number	:	920-563-8468
Fax Number	:	920-563-0178

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/27/2020

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