Provider Demographics
NPI:1265729222
Name:SARRAFZADEH, YOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:YOSEPH
Middle Name:
Last Name:SARRAFZADEH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:SARRAFZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3735 WILD GINGER WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53126-9374
Mailing Address - Country:US
Mailing Address - Phone:916-266-3434
Mailing Address - Fax:
Practice Address - Street 1:3719 80TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4950
Practice Address - Country:US
Practice Address - Phone:262-697-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14199152W00000X
WI3246-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist