MEDICARE: SANDRINE TAGNI KOUNGA 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	3394-35	WI

General Provider Information

NPI Number	:	1992172951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRINE TAGNI KOUNGA OD

Provider Business Mailing Address
First Line	:	4101 N 56TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1267
Country	:	US
Telephone Number	:	414-447-9403
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 N 56TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1267
Country	:	US
Telephone Number	:	414-447-9403
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	02/25/2021

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