Provider Demographics
NPI:1851529309
Name:KYSER, MARCY K (OD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:K
Last Name:KYSER
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 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:608-475-3374
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:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3331-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100036360Medicaid
WI100036360Medicaid
IL046010210Medicaid