Provider Demographics
NPI:1215242334
Name:EDWARD J TOMASIK & ASSOCIATE OPTOMETRISTS INC.
Entity type:Organization
Organization Name:EDWARD J TOMASIK & ASSOCIATE OPTOMETRISTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:414-744-0449
Mailing Address - Street 1:3552 E LAYTON AVE
Mailing Address - Street 2:PO BOX 100200
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1409
Mailing Address - Country:US
Mailing Address - Phone:414-744-0449
Mailing Address - Fax:414-744-1315
Practice Address - Street 1:3552 E LAYTON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1409
Practice Address - Country:US
Practice Address - Phone:414-744-0449
Practice Address - Fax:414-744-1315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD J TOMASIK & ASSOCIATE OPTOMETRISTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42838500Medicaid