Provider Demographics
NPI:1174753248
Name:MICHALSKI, KATIE J (OD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:J
Last Name:MICHALSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:J
Other - Last Name:KNOEDLER MICHALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:800 N 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-261-8500
Mailing Address - Fax:715-261-8665
Practice Address - Street 1:800 N 1ST STREET
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-261-8500
Practice Address - Fax:715-261-8556
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3160-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist