Active NPI
Ophthalmology Associates S C
- Ophthalmology Physician
- New Berlin, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- OPHTHALMOLOGY ASSOCIATES S C
- Practice address
- 14555 W National Ave
New Berlin, WI 53151-4494 - Phone
- (262) 784-3937
- NPI assigned
- Feb 20, 2007
- Last updated
- Apr 23, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Glenn Graves, MD
- Title
- Owner Partner
- Phone
- (414) 294-4660
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | NU | ||
| Optometrist | 152W00000X | NU | ||
| Ophthalmology Physician | 207W00000X | NU | Primary |
Addresses
Primary practice location
14555 W National Ave
New Berlin, WI 53151-4494
Mailing address
6020 S Packard Ave
Cudahy, WI 53110-3028
Phone (414) 294-4660
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32758700 | Medicaid | WI | |
| CO1849 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20100930021445 | WI | DME Supplier - Physician - Optometrist | 6204723869 | Practice locations: New Berlin, WI |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Ophthalmology Physician
- Hales Corners, WI
- NPI 1689719437
O20040301000212
National Provider Directory
National Provider Directory- Tax ID family
- Ophthalmology Associates
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Cudahy, WI
- NPI 1790998581
-
- Ophthalmology Physician
- Cudahy, WI
- NPI 1063557890
-
- Ophthalmology Physician
- New Berlin, WI
- NPI 1336024025
-
- Ophthalmology Physician
- Greenfield, WI
- NPI 1720543614
Locations
14300 W National Ave
Ste 200
New Berlin, WI 53151
Phone (262) 784-3937
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Glaucoma Specialist (Ophthalmology) Physician
- Greenfield, WI
- NPI 1780671677
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": "1713830400000",
"number": "1730224585",
"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": "14555 W NATIONAL AVE",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531514494",
"telephone_number": "262-784-3937"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OPHTHALMOLOGY ASSOCIATES S C",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-20",
"last_updated": "2024-04-23",
"certification_date": "2024-04-23",
"status": "A",
"authorized_official_last_name": "GRAVES",
"authorized_official_first_name": "GLENN",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NU",
"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 New Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.