Provider Demographics
NPI:1952541617
Name:ASHLAND EYE SPECIALIST, SC
Entity Type:Organization
Organization Name:ASHLAND EYE SPECIALIST, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-682-0482
Mailing Address - Street 1:2101 BEASER AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3638
Mailing Address - Country:US
Mailing Address - Phone:715-682-0482
Mailing Address - Fax:715-682-4297
Practice Address - Street 1:2101 BEASER AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3638
Practice Address - Country:US
Practice Address - Phone:715-682-0482
Practice Address - Fax:715-682-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34834207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31971900Medicaid
WI31971900Medicaid
WI04081Medicare PIN