# THOMAS ERIC HERZOG INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Indianhead Eye Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902887508
- **Authorized official:** MR. THOMAS ERIC HERZOG (OPTICIAN/OWNER)
- **Authorized official phone:** (715) 635-3127

## Contact information

- **Practice address:** W7164 GREEN VALLEY RD, SPOONER, WI 54801-6605
- **Practice address phone:** (715) 635-3127
- **Practice address fax:** (715) 635-3316
- **Mailing address:** PO BOX 446, SPOONER, WI 54801-0446
- **Mailing address phone:** (715) 635-3127
- **Mailing address fax:** (715) 635-3316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/10/2005
- **Last updated:** 01/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 38711400 | — | WI |
| 01 | — | DG1708 | PALMETTO RR MEDICARE | WI |