Healthcare Provider Details

I. General information

NPI: 1962687046
Provider Name (Legal Business Name): THOMAS JOSEPH VIERLING JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 2ND AVE S
ONALASKA WI
54650-3217
US

IV. Provider business mailing address

515 2ND AVE S
ONALASKA WI
54650-3217
US

V. Phone/Fax

Practice location:
  • Phone: 608-781-6881
  • Fax: 608-781-1762
Mailing address:
  • Phone: 608-781-6881
  • Fax: 608-781-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1212-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: