Organization
THOMAS ERIC HERZOG INC
Active
Other names
Indianhead Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS ERIC HERZOG (OPTICIAN/OWNER)
(715) 635-3127
Entity
Organization
Contact information
Practice address
W7164 GREEN VALLEY RD, SPOONER, WI 54801-6605
(715) 635-3127
(715) 635-3316
Mailing address
PO BOX 446, SPOONER, WI 54801-0446
(715) 635-3127
(715) 635-3316
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38711400
—
WI
01
—
DG1708
PALMETTO RR MEDICARE
WI
Enumeration date
11/10/2005
Last updated
01/16/2014
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