Individual
WILLIAM GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5134 6TH AVE, KENOSHA, WI 53140-3404
(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
02/13/2007
Last updated
07/08/2007
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