Provider Demographics
NPI:1508253048
Name:RAEVIS, JOSEPH III
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:RAEVIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W JOHNSON ST APT 934
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 SYCAMORE AVE STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1208
Practice Address - Country:US
Practice Address - Phone:732-530-7730
Practice Address - Fax:732-530-3837
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology