Provider Demographics
NPI:1306022116
Name:HARRY A. EASOM, M.D., S.C.
Entity Type:Organization
Organization Name:HARRY A. EASOM, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EASOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-271-7200
Mailing Address - Street 1:377 W RIVER WOODS PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1088
Mailing Address - Country:US
Mailing Address - Phone:414-271-7200
Mailing Address - Fax:414-271-7278
Practice Address - Street 1:377 W RIVER WOODS PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1088
Practice Address - Country:US
Practice Address - Phone:414-271-7200
Practice Address - Fax:414-271-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14484207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty