Provider Demographics
NPI:1558921197
Name:PRZISLICKI, HEIDI ANNE FENSKE (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNE FENSKE
Last Name:PRZISLICKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANNE
Other - Last Name:FENSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5722 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-1911
Mailing Address - Country:US
Mailing Address - Phone:414-786-2941
Mailing Address - Fax:414-235-9544
Practice Address - Street 1:5722 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-1911
Practice Address - Country:US
Practice Address - Phone:414-786-2941
Practice Address - Fax:414-235-9544
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3563-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist