Provider Demographics
NPI:1356622898
Name:PRN EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:PRN EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:KNOUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-352-7932
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 1:950 PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-204-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
147398OtherPTAN
WIU98047Medicare UPIN