Provider Demographics
NPI:1821063009
Name:DOYLE KESZO, ROXANNE (OD)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:DOYLE KESZO
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:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-0513
Mailing Address - Country:US
Mailing Address - Phone:715-526-3163
Mailing Address - Fax:715-526-4019
Practice Address - Street 1:150A COUNTY RD B
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-7072
Practice Address - Country:US
Practice Address - Phone:715-526-3163
Practice Address - Fax:715-526-4019
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2963-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI00074260Medicare PIN
WIU97843Medicare UPIN