Healthcare Provider Details

I. General information

NPI: 1750556049
Provider Name (Legal Business Name): TOMAHAWK EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S TOMAHAWK AVE
TOMAHAWK WI
54487-1223
US

IV. Provider business mailing address

28 S TOMAHAWK AVE
TOMAHAWK WI
54487-1223
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: SHAWN R MARQUARDT
Title or Position: OWNER
Credential:
Phone: 715-224-2200