MEDICARE: WILLIAM D. TANKE, OD, PA

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	OPC001868	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306133285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM D. TANKE, OD, PA

Provider Business Mailing Address
First Line	:	2652 GLASBERN CIR
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-8075
Country	:	US
Telephone Number	:	321-412-3487
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 W NEW HAVEN AVE
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-3930
Country	:	US
Telephone Number	:	321-951-2020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM D. TANKE
Credential	:	O.D.
Telephone Number	:	321-412-3487

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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