# DJ KONTRA MD & ASSOCIATES SC

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

## Provider details

- **NPI number:** 1992794911
- **Authorized official:** DENNIS J KONTRA MD (PRESIDENT)
- **Authorized official phone:** (262) 886-9100

## Contact information

- **Practice address:** 5802 WASHINGTON AVE, STE 102, RACINE, WI 53406-4050
- **Practice address phone:** (262) 886-9100
- **Practice address fax:** (262) 886-9130
- **Mailing address:** 5802 WASHINGTON AVE, STE 102, RACINE, WI 53406-4050
- **Mailing address phone:** (262) 886-9100
- **Mailing address fax:** (262) 886-9130

## Taxonomy

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

## Other

- **Enumeration date:** 10/21/2005
- **Last updated:** 04/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32784900 | — | WI |
| 01 | — | CT1058 | RAILROAD MEDICARE | WI |