Organization
GRANGE VISION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN MARK WACLAWSKI O.D. (PRESIDENT)
(414) 281-4800
Entity
Organization
Contact information
Practice address
5312 S 27TH ST, MILWAUKEE, WI 53221-3724
(414) 281-4800
(414) 281-4891
Mailing address
5312 S 27TH ST, MILWAUKEE, WI 53221-3724
(414) 281-4800
(414) 281-4891
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1768
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38400800
—
WI
Enumeration date
02/22/2007
Last updated
01/18/2008
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