Provider Demographics
NPI:1306099338
Name:TASHNER VISION CLINIC LLC
Entity type:Organization
Organization Name:TASHNER VISION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:TASHNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-348-2515
Mailing Address - Street 1:170 MCGREGOR PLAZA
Mailing Address - Street 2:PO BOX 22
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-0022
Mailing Address - Country:US
Mailing Address - Phone:608-348-2515
Mailing Address - Fax:608-348-2574
Practice Address - Street 1:170 MCGREGOR PLAZA
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-0022
Practice Address - Country:US
Practice Address - Phone:608-348-2515
Practice Address - Fax:608-348-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1266790001Medicare NSC
WI000047188Medicare PIN