Provider Demographics
NPI:1184727729
Name:TARPENNING & ASSOCIATES
Entity type:Organization
Organization Name:TARPENNING & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HEINSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-234-1511
Mailing Address - Street 1:2900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868
Mailing Address - Country:US
Mailing Address - Phone:715-234-1511
Mailing Address - Fax:715-434-1513
Practice Address - Street 1:2900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868
Practice Address - Country:US
Practice Address - Phone:715-234-1511
Practice Address - Fax:715-434-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 332H00000X
WI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38419400Medicaid
WI=========OtherSECURITY
WI=========018OtherBCBS