Provider Demographics
NPI:1780613083
Name:KNEISLEY, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:KNEISLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 LIMESTONE RD STE 128
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1253
Mailing Address - Country:US
Mailing Address - Phone:302-239-1933
Mailing Address - Fax:302-239-1002
Practice Address - Street 1:5301 LIMESTONE RD STE 128
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1253
Practice Address - Country:US
Practice Address - Phone:302-239-1933
Practice Address - Fax:302-239-1002
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE807535SOSMedicare ID - Type Unspecified
DEU59713Medicare UPIN