Provider Demographics
NPI:1518013762
Name:TIONGSON OPHTHALMOLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:TIONGSON OPHTHALMOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATANACIO
Authorized Official - Middle Name:HENSON
Authorized Official - Last Name:TIONGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-722-1212
Mailing Address - Street 1:1315 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1556
Mailing Address - Country:US
Mailing Address - Phone:574-722-1212
Mailing Address - Fax:574-753-9493
Practice Address - Street 1:1315 SMITH ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1556
Practice Address - Country:US
Practice Address - Phone:574-722-1212
Practice Address - Fax:574-753-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028875A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0312610001Medicare NSC