Healthcare Provider Details

I. General information

NPI: 1821159435
Provider Name (Legal Business Name): CARLSON TILLISCH EYE CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 N BROADWAY ST
NEW ULM MN
56073-1747
US

IV. Provider business mailing address

PO BOX 156
NEW ULM MN
56073-0156
US

V. Phone/Fax

Practice location:
  • Phone: 507-354-7407
  • Fax:
Mailing address:
  • Phone: 507-354-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TARA BUTSON
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 507-345-5087