Provider Demographics
NPI:1760829568
Name:DR STEPHEN P TONNER LTD
Entity Type:Organization
Organization Name:DR STEPHEN P TONNER LTD
Other - Org Name:OTTERTAIL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:TONNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-583-4673
Mailing Address - Street 1:603 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:MN
Mailing Address - Zip Code:56551-4109
Mailing Address - Country:US
Mailing Address - Phone:218-583-4673
Mailing Address - Fax:218-548-5671
Practice Address - Street 1:603 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-4109
Practice Address - Country:US
Practice Address - Phone:218-583-4673
Practice Address - Fax:218-548-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04488Medicare UPIN