Provider Demographics
NPI:1356432199
Name:KNOUS, KRISTOPHER T (OD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:T
Last Name:KNOUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1459
Mailing Address - Country:US
Mailing Address - Phone:262-352-7932
Mailing Address - Fax:
Practice Address - Street 1:1414 N TAYLOR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1988
Practice Address - Country:US
Practice Address - Phone:920-208-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38625000Medicaid
WI3946025Medicare ID - Type Unspecified
WI38625000Medicaid