MEDICARE: WILLIAM DODDS TANKE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC 1868	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3492910	OTHER	FL	AETNA HMO
2	20091	OTHER	FL	BLUE CROSS BLUE SHIELD
3	7792285	OTHER	FL	AETNA PPO
4	9350415	OTHER	FL	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982608220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DODDS TANKE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 120160
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32912-0160
Country	:	US
Telephone Number	:	321-951-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 WEST NEW HAVEN AVENUE
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-3930
Country	:	US
Telephone Number	:	321-951-2220
Fax Number	:	321-722-4754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/22/2014

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