Provider Demographics
NPI:1467757757
Name:CORGAN VISION CLINIC, S.C.
Entity Type:Organization
Organization Name:CORGAN VISION CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-330-5570
Mailing Address - Street 1:2706 CAHILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-3886
Mailing Address - Country:US
Mailing Address - Phone:715-330-5570
Mailing Address - Fax:715-330-5369
Practice Address - Street 1:2706 CAHILL RD STE E
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3886
Practice Address - Country:US
Practice Address - Phone:715-330-5570
Practice Address - Fax:715-330-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty