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 1:16800 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3533
Mailing Address - Country:US
Mailing Address - Phone:262-432-2005
Mailing Address - Fax:262-432-2006
Practice Address - Street 1:5725 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3603
Practice Address - Country:US
Practice Address - Phone:262-694-5553
Practice Address - Fax:262-923-7621
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14199152W00000X
WI3246-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist