Corgan Vision Clinic, S.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2655 Issued in WI

Legal business name

CORGAN VISION CLINIC, S.C.

Practice address

2706 Cahill Rd Ste E
Marinette, WI 54143-3886

Phone

(715) 330-5570

Fax

(715) 330-5369

NPI assigned

Jan 18, 2011

Last updated

Jun 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy CorganNPI 1790731743

Title

Optometrist

Phone

(715) 330-5570

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Corgan, O.D.

  • Optometrist
  • Marinette, WI
  • NPI 1790731743
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1467757757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2706 CAHILL RD STE E",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433886",
            "telephone_number": "715-330-5570",
            "fax_number": "715-330-5369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2706 CAHILL RD STE E",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433886",
            "telephone_number": "715-330-5570",
            "fax_number": "715-330-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORGAN VISION CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-18",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "CORGAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "715-330-5570"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Ann Conklin, PHARMD
• Julie R Conley, PHYSICAL THERAPIST
• Mitchell C Connell, LPC
• Lisa R Cook, NP
• Robert James Cooper, CRNA
• Timothy Corgan, O.D.
• Cornerstone Caregiving East LLC
• Cornerstone Christian Counseling LLC
• Robin Corwin, APNP
• Kaitlyn Rose Couillard, PTA

• Optometrist in Marinette, WI
• Providers in Marinette, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.