Tillman Optometry LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

TILLMAN OPTOMETRY LLC

Practice address

2304 S Main St
Rice Lake, WI 54868-2900

Phone

(715) 736-1700

NPI assigned

Nov 21, 2005

Organization subpart

No

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

Authorized official

Name

Robert E Tillman, OD

Title

Owner

Phone

(715) 736-1700

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1538142989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 S MAIN ST",
            "address_2": "TILLMAN OPTOMETRY",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682900",
            "telephone_number": "715-736-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 S MAIN ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682900",
            "telephone_number": "715-736-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLMAN OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-21",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-736-1700",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WEA",
            "identifier": "130004329",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38563500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dianne Marie Thompson, H.I.S.
• Alison Joe Thorpe
• Angela P Tiepelman, RN
• Robert E Tillman, OD
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• Sarah Tomesh, PAC
• Donald Roy Torgerson, DDS
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• Eyewear Supplier in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Eyewear Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.