Healthcare Provider Details

I. General information

NPI: 1235202318
Provider Name (Legal Business Name): TOMAHAWK EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date: 01/10/2023
Reactivation Date: 01/13/2023

III. Provider practice location address

1334 N 4TH ST SUITE 101
TOMAHAWK WI
54487-2137
US

IV. Provider business mailing address

1334 N 4TH ST SUITE 101
TOMAHAWK WI
54487-2137
US

V. Phone/Fax

Practice location:
  • Phone: 715-224-2200
  • Fax:
Mailing address:
  • Phone: 715-224-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN R MARQUARDT
Title or Position: PRESIDENT
Credential:
Phone: 715-224-2200