Provider Demographics
NPI:1528184801
Name:CULVER, THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CULVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3046
Mailing Address - Country:US
Mailing Address - Phone:608-782-7127
Mailing Address - Fax:608-782-7124
Practice Address - Street 1:2104 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3046
Practice Address - Country:US
Practice Address - Phone:608-782-7127
Practice Address - Fax:608-782-7124
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38509300Medicare ID - Type Unspecified
WIT61709Medicare UPIN
WI000387036Medicare PIN
WI410015890Medicare PIN