Provider Demographics
NPI:1982608220
Name:TANKE, WILLIAM DODDS (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DODDS
Last Name:TANKE
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:PO BOX 120160
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-0160
Mailing Address - Country:US
Mailing Address - Phone:321-951-2220
Mailing Address - Fax:
Practice Address - Street 1:1813 WEST NEW HAVEN AVENUE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3930
Practice Address - Country:US
Practice Address - Phone:321-951-2220
Practice Address - Fax:321-722-4754
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3492910OtherAETNA HMO
FL20091OtherBLUE CROSS BLUE SHIELD
FL7792285OtherAETNA PPO
FL9350415OtherCIGNA
FL078289100Medicaid
FL3492910OtherAETNA HMO