Provider Demographics
NPI:1144518507
Name:BISANAR, KATHLEEN S (OD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:BISANAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:S
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9739 GILES RD
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2930
Mailing Address - Country:US
Mailing Address - Phone:402-963-0831
Mailing Address - Fax:
Practice Address - Street 1:9739 GILES RD
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2930
Practice Address - Country:US
Practice Address - Phone:402-963-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist