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NPI Code Detail

MEDICARE: SOUTHEAST EYE SC

MEDICARE: SOUTHEAST EYE SC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

General Provider Information

NPI Number : 1578162558
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST EYE SC
Provider Business Mailing Address
First Line : 6125 GREEN BAY RD STE 800
Second Line :
City : KENOSHA
State : WI
Zip : 53142-2982
Country : US
Telephone Number : 262-654-0726
Fax Number :
Provider Business Practice Location Address
First Line : 6125 GREEN BAY RD STE 800
Second Line :
City : KENOSHA
State : WI
Zip : 53142-2982
Country : US
Telephone Number : 262-654-0726
Fax Number : 262-654-4365
Authorized Official
Title or Position : OWNER/PHYSICAN
Name : DR. RAFFI D KARAPETIAN
Credential : D.O.
Telephone Number : 262-654-0726
Provider Enumeration Date : 10/21/2020
Last Update Date : 04/02/2021

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Directions to “SOUTHEAST EYE SC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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