Provider Demographics
NPI:1225063514
Name:SAWALLISH, TAMMI L (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMMI
Middle Name:L
Last Name:SAWALLISH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-0228
Mailing Address - Country:US
Mailing Address - Phone:920-361-1696
Mailing Address - Fax:920-361-1247
Practice Address - Street 1:269 MEMORIAL DR STE 103
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1243
Practice Address - Country:US
Practice Address - Phone:920-361-1696
Practice Address - Fax:920-361-1247
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3047-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38630100Medicaid