Healthcare Provider Details

I. General information

NPI: 1093623985
Provider Name (Legal Business Name): ANUSHA GHAFFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N95W18161 APPLETON AVE LOT 103
MENOMONEE FALLS WI
53051-1325
US

IV. Provider business mailing address

N95W18161 APPLETON AVE LOT 103
MENOMONEE FALLS WI
53051-1325
US

V. Phone/Fax

Practice location:
  • Phone: 262-251-1378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4159-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: