Provider Demographics
NPI:1598445850
Name:KNEIERT, ANNA NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NICOLE
Last Name:KNEIERT
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 1:3616 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9665
Mailing Address - Country:US
Mailing Address - Phone:608-751-5038
Mailing Address - Fax:
Practice Address - Street 1:3341 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6566
Practice Address - Country:US
Practice Address - Phone:715-423-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3922-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist