Provider Demographics
NPI:1750556049
Name:TOMAHAWK EYE CARE
Entity type:Organization
Organization Name:TOMAHAWK EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARQUARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-224-2200
Mailing Address - Street 1:28 S TOMAHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-1223
Mailing Address - Country:US
Mailing Address - Phone:715-224-2200
Mailing Address - Fax:
Practice Address - Street 1:28 S TOMAHAWK AVE
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1223
Practice Address - Country:US
Practice Address - Phone:715-224-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4519380001Medicare NSC