Provider Demographics
NPI:1386743425
Name:MLSNA, MARK A (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MLSNA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:N89W16785 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2071
Mailing Address - Country:US
Mailing Address - Phone:262-253-4000
Mailing Address - Fax:262-253-4100
Practice Address - Street 1:N89W16785 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2071
Practice Address - Country:US
Practice Address - Phone:262-253-4000
Practice Address - Fax:262-253-4100
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WITPA 2057-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDA9707Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUPID
WI0210Medicare ID - Type UnspecifiedDR. MARK A. MLSNA
WIV18837Medicare UPIN
WI5177280001Medicare NSC