Provider Demographics
NPI:1528059342
Name:TASHNER, MICHAEL L (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:TASHNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MCGREGOR PLZ
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 PLZ
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
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38588500Medicaid
WIU43832Medicare UPIN
WI471880001Medicare PIN
WI1266790001Medicare NSC