# OPHTHALMOLOGY ASSOCIATES S C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689719437
- **Authorized official:** DR. GLENN GRAVES MD (OWNER PARTNER)
- **Authorized official phone:** (414) 294-4660

## Contact information

- **Practice address:** 6080 S 108TH ST, HALES CORNERS, WI 53130-2557
- **Practice address phone:** (414) 425-9002
- **Mailing address:** 6020 S PACKARD AVE, CUDAHY, WI 53110-3028
- **Mailing address phone:** (414) 294-4660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 332H00000X | Eyewear Supplier | — | NULL | — |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 10/25/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32758700 | — | WI |
| 01 | — | CO1849 | RAILROAD MEDICARE | — |