Provider Demographics
NPI: | 1497707921 |
---|---|
Name: | CONNOR, THOMAS B JR (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | THOMAS |
Middle Name: | B |
Last Name: | CONNOR |
Suffix: | JR |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 925 N 87TH ST |
Mailing Address - Street 2: | THE EYE INSTITUTE |
Mailing Address - City: | MILWAUKEE |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53226-4812 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 414-456-7868 |
Mailing Address - Fax: | 414-456-6300 |
Practice Address - Street 1: | 925 N 87TH ST |
Practice Address - Street 2: | THE EYE INSTITUTE |
Practice Address - City: | MILWAUKEE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53226-4812 |
Practice Address - Country: | US |
Practice Address - Phone: | 414-456-7868 |
Practice Address - Fax: | 414-456-6300 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-16 |
Last Update Date: | 2013-03-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 35377 | 207W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 1497707921 | Medicaid | |
180024944 | Other | RAILROAD MEDICARE | |
002000113C | Other | HUMANA | |
002000113C | Other | HUMANA | |
180024944 | Other | RAILROAD MEDICARE | |
WI | 1497707921 | Medicaid |