Healthcare Provider Details

I. General information

NPI: 1336024025
Provider Name (Legal Business Name): OPHTHALMOLOGY ASSOCIATES S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 WEST NATIONAL AVE SUITE 200
NEW BERLIN WI
53151
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 262-784-3937
  • Fax:
Mailing address:
  • Phone: 414-281-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: TONI BERTINO
Title or Position: CREDENTIALING
Credential:
Phone: 414-294-4660