NPIMap

Organization Active NPI

Ophthalmology Associates S C

  • Ophthalmology Physician
  • Milwaukee, WI
National Provider Identifier
1255476099
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
OPHTHALMOLOGY ASSOCIATES S C
Practice address
2500 W Layton Ave
Suite 110
Milwaukee, WI 53221-5420
Phone
(414) 281-0424
NPI assigned
Feb 20, 2007
Last updated
Oct 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Glenn E Graves, MDNPI 1780671677
Title
Owner Partner
Phone
(414) 294-4660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X
Optometrist 152W00000X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

2500 W Layton Ave
Suite 110
Milwaukee, WI 53221-5420

Mailing address

6020 S Packard Ave
Cudahy, WI 53110-3028
Phone (414) 294-4660

Other identifiers 2

IdentifierTypeStateIssuer
32758700MedicaidWI
CO1849OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000212 WI Part B Supplier - Clinic/Group Practice 6204723869 Receives reassigned benefits from 9 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cudahy, WI; Greenfield, WI; New Berlin, WI

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

6020 S Packard Ave
Cudahy, WI 53110
Phone (414) 294-4660

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1255476099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 S PACKARD AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103028",
            "telephone_number": "414-294-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W LAYTON AVE",
            "address_2": "SUITE 110",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215420",
            "telephone_number": "414-281-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY ASSOCIATES S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "414-294-4660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32758700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CO1849",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.