Provider Demographics
NPI:1194866624
Name:PILESKI-PERONA, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:PILESKI-PERONA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 218TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WI
Mailing Address - Zip Code:53104-9733
Mailing Address - Country:US
Mailing Address - Phone:262-586-5034
Mailing Address - Fax:262-554-1523
Practice Address - Street 1:5744 DURAND AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5054
Practice Address - Country:US
Practice Address - Phone:262-554-6555
Practice Address - Fax:262-554-1523
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2460-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist