Provider Demographics
NPI:1881647030
Name:TOELLNER, RICHARD RAYMOND (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RAYMOND
Last Name:TOELLNER
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 1:1640 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1106
Mailing Address - Country:US
Mailing Address - Phone:920-725-3752
Mailing Address - Fax:920-722-3195
Practice Address - Street 1:1640 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1106
Practice Address - Country:US
Practice Address - Phone:920-725-3752
Practice Address - Fax:920-722-3195
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2340-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000187730Medicare ID - Type Unspecified
WI38579000Medicare ID - Type Unspecified
WIU21310Medicare UPIN