Organization
EYE WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY GRANT OD (OWNER / OPTOMETRIST)
(901) 496-9129
Entity
Organization
Contact information
Practice address
401 N MILWAUKEE ST STE 3, WATERFORD, WI 53185-4493
(262) 534-9100
Mailing address
1090 BUCKS POND RD, MONTICELLO, IL 61856-8058
(901) 496-9129
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
05/27/2022
Last updated
05/27/2022
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