Grange Vision Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1768 Issued in WI

Legal business name

GRANGE VISION CENTER, INC.

Practice address

5312 S 27TH St
Milwaukee, WI 53221-3724

Phone

(414) 281-4800

Fax

(414) 281-4891

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Mark Waclawski, O.D.

Title

President

Phone

(414) 281-4800

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200614400000",
    "number": "1912032731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5312 S 27TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532213724",
            "telephone_number": "414-281-4800",
            "fax_number": "414-281-4891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5312 S 27TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532213724",
            "telephone_number": "414-281-4800",
            "fax_number": "414-281-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGE VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2008-01-18",
        "status": "A",
        "authorized_official_last_name": "WACLAWSKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-281-4800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38400800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Robert Vincent Granatelli
• Paige Elizabeth Granberg
• Grand Rising PNCC
• Cheryl A. Grandlich, N.P.
• Holly Granfield, DDS
• Britt Alyssa Granholm, PHARMD
• Lisa Joan Granica, RN
• Kristin M. Granlund, PA-C
• Hailee Grannan
• Granny'S Houses Home Care Inc

• Optometrist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.