Provider Demographics
NPI:1588639371
Name:MORRIS, TONY R (OD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:R
Last Name:MORRIS
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:P O BOX 147
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736
Mailing Address - Country:US
Mailing Address - Phone:715-672-8981
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736
Practice Address - Country:US
Practice Address - Phone:715-672-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03S04MOOtherBCBS OF MN
MN454K3MOOtherBCBS OF MN
MNA65371016545OtherPREFERRED ONE
WI38600800Medicaid
MN03S04MOOtherBCBS OF MN
WI000247340Medicare ID - Type Unspecified
WI38600800Medicaid