Organization
MILWAUKEE VA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH MICHAEL ROSE O.D. (OPTOMETRIST)
(414) 384-2000
Entity
Organization
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(414) 384-2000
Mailing address
3712 W SOUTHLAND DR, FRANKLIN, WI 53132-8439
(414) 304-1379
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
2879-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2879-035
OPTOMETRY STATE ID
WI
Enumeration date
07/23/2006
Last updated
08/22/2020
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