Healthcare Provider Details

I. General information

NPI: 1720543614
Provider Name (Legal Business Name): OPHTHALMOLOGY ASSOCIATES S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 W LOOMIS RD STE 310
GREENFIELD WI
53220-4858
US

IV. Provider business mailing address

6020 S PACKARD AVE
CUDAHY WI
53110-3028
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-0424
  • Fax: 414-281-0959
Mailing address:
  • Phone: 414-294-4660
  • Fax: 414-294-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS V.P. ALPREN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 414-281-0424