OrganizationActive
Dr Wagner Southridge Optical LLC
NPI 1255591236 · Eyewear Supplier · Greendale, WI
Provider details
- NPI number
- 1255591236
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Joan Serrano, Manager(414) 855-0469
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5300 S 76th St
Ste 690
Greendale, WI 53129-1102
Phone: (414) 855-0469
Fax: (414) 855-0492
Street-level locationGet directions
Mailing address
5300 S 76th St
Greendale, WI 53129-1102
Registry dates
- Enumerated
- 2008-06-12
- Last updated
- 2009-08-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.