Organization
WATERTOWN PHYSICIAN PRACTICES LLC
Active
Other names
WRMC Center for Eye Wear
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
123 HOSPITAL DR STE 2005, WATERTOWN, WI 53098
(920) 206-3155
(920) 206-3158
Mailing address
680 S 4TH ST, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
05/14/2018
Last updated
06/26/2025
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