Organization
HARBORSIDE EYE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM R GRADY OD (OWNER)
(262) 652-2020
Entity
Organization
Contact information
Practice address
5134 - 6TH AVENUE, KENOSHA, WI 53140-0000
(262) 652-2020
Mailing address
5134 6TH AVE, KENOSHA, WI 53140-3404
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2215 - 035
WI
Other
Enumeration date
02/09/2012
Last updated
04/19/2012
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