MEDICARE: OPHTHALMOLOGY ASSOCIATES

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0565030001	OTHER	WI	DMERC (MC DURABLE MEDICAL

General Provider Information

NPI Number	:	1790998581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY ASSOCIATES

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	:	414-543-6887
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	GLENN E GRAVES
Credential	:	MD
Telephone Number	:	414-543-6887

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	03/08/2024

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