Provider Demographics
NPI:1457353435
Name:HARVEY, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 E HAMILTON AVE # 110
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6863
Mailing Address - Country:US
Mailing Address - Phone:715-449-8410
Mailing Address - Fax:715-834-0373
Practice Address - Street 1:2751 COMMERCIAL BLVD STE 6
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5080
Practice Address - Country:US
Practice Address - Phone:715-449-8400
Practice Address - Fax:715-449-8400
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47806-20207WX0120X
WI47806-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34647300Medicaid
I28544Medicare UPIN
WIP00226733Medicare PIN