Provider Demographics
NPI:1306837273
Name:THOMAS J MUNNS
Entity Type:Organization
Organization Name:THOMAS J MUNNS
Other - Org Name:MADISON OPTOMETRIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-251-1515
Mailing Address - Street 1:615 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-1015
Mailing Address - Country:US
Mailing Address - Phone:608-251-1515
Mailing Address - Fax:608-251-5966
Practice Address - Street 1:615 STATE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1015
Practice Address - Country:US
Practice Address - Phone:608-251-1515
Practice Address - Fax:608-251-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty