Provider Demographics
NPI:1578162558
Name:SOUTHEAST EYE SC
Entity Type:Organization
Organization Name:SOUTHEAST EYE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:D
Authorized Official - Last Name:KARAPETIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:262-654-0726
Mailing Address - Street 1:6125 GREEN BAY RD STE 800
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2982
Mailing Address - Country:US
Mailing Address - Phone:262-654-0726
Mailing Address - Fax:
Practice Address - Street 1:6125 GREEN BAY RD STE 800
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2982
Practice Address - Country:US
Practice Address - Phone:262-654-0726
Practice Address - Fax:262-654-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty