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Organization
OPHTHALMOLOGY ASSOCIATES S C
Active
Organization
OPHTHALMOLOGY ASSOCIATES S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN GRAVES MD (OWNER PARTNER)
(414) 294-4660
Entity
Organization
Contact information
Practice address
6080 S 108TH ST, HALES CORNERS, WI 53130-2557
(414) 425-9002
Mailing address
6020 S PACKARD AVE, CUDAHY, WI 53110-3028
(414) 294-4660
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
332H00000X
Eyewear Supplier
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32758700
—
WI
01
—
CO1849
RAILROAD MEDICARE
—
Enumeration date
02/20/2007
Last updated
10/25/2007
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