Organization
TILLMAN OPTOMETRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E TILLMAN OD (OWNER)
(715) 736-1700
Entity
Organization
Contact information
Practice address
2304 S MAIN ST, RICE LAKE, WI 54868-2900
(715) 736-1700
Mailing address
2304 S MAIN ST, TILLMAN OPTOMETRY, RICE LAKE, WI 54868-2900
(715) 736-1700
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130004329
WEA
WI
05
—
38563500
—
WI
Enumeration date
11/21/2005
Last updated
02/20/2012
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