Provider Demographics
NPI:1992172951
Name:TAGNI KOUNGA, SANDRINE (OD)
Entity type:Individual
Prefix:
First Name:SANDRINE
Middle Name:
Last Name:TAGNI KOUNGA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1267
Mailing Address - Country:US
Mailing Address - Phone:414-447-9403
Mailing Address - Fax:
Practice Address - Street 1:4101 N 56TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1267
Practice Address - Country:US
Practice Address - Phone:414-447-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3394-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist