Provider Demographics
NPI:1821365677
Name:DR MARCY KYSER L.L.C.
Entity Type:Organization
Organization Name:DR MARCY KYSER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KYSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-579-9555
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-0356
Mailing Address - Country:US
Mailing Address - Phone:608-475-3374
Mailing Address - Fax:608-579-9555
Practice Address - Street 1:100 W COURT ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2343
Practice Address - Country:US
Practice Address - Phone:608-579-9555
Practice Address - Fax:608-579-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R163285Medicare PIN