MEDICARE: OPHTHALMOLOGY ASSOCIATES S C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier
3	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CO1849	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063557890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY ASSOCIATES S C

Provider Business Mailing Address
First Line	:	6020 S PACKARD AVE
Second Line	:
City	:	CUDAHY
State	:	WI
Zip	:	53110-3028
Country	:	US
Telephone Number	:	414-294-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 S PACKARD AVE
Second Line	:
City	:	CUDAHY
State	:	WI
Zip	:	53110-3028
Country	:	US
Telephone Number	:	414-294-4660
Fax Number	:

Authorized Official
Title or Position	:	PARTNER OWNER
Name	:	DR. GLENN E GRAVES
Credential	:	MD
Telephone Number	:	414-294-4660

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	04/23/2024

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