Organization
EYE XAMZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE L HAGOPIAN IV COT,CRA (PRESIDENT)
(262) 705-8947
Entity
Organization
Contact information
Practice address
7532 PERSHING BLVD, KENOSHA, WI 53142-4316
(262) 705-8947
(262) 586-0062
Mailing address
7419 256TH AVE, SALEM, WI 53168-9158
(262) 705-8947
(262) 586-0062
Taxonomy
Speciality
Code
Description
License number
State
156FX1202X
Optometric Technician
Primary
—
—
Other
Enumeration date
04/07/2008
Last updated
05/12/2015
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