Timothy Corgan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2655-035 Issued in WI

Practice address

1400 University Dr
Suite 101
Marinette, WI 54143-5105

Phone

(715) 732-4181

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Timothy Corgan Professional name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Corgan Vision Clinic, S.C.

  • Optometrist
  • Marinette, WI
  • NPI 1467757757
  Medicare reassignment NPD Authorized official
• Victorian Eyes

  • Eyewear Supplier
  • Marinette, WI
  • NPI 1427245042
  NPD
• Brian E. Bozelka, MD SC

  • Ophthalmology Physician
  • Marinette, WI
  • NPI 1659568657
  NPD (past)
• Shopko Stores Operating Co LLC

  • Community/Retail Pharmacy
  • Eau Claire, WI
  • NPI 1720034176
  NPD (past)
• Shopko Stores Operating Co. LLC

  • Eyewear Supplier
  • Albert Lea, MN
  • NPI 1528010642
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1790731743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 UNIVERSITY DR",
            "address_2": "SUITE 101",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541435105",
            "telephone_number": "715-732-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 UNIVERSITY DR",
            "address_2": "SUITE 101",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541435105",
            "telephone_number": "715-732-4181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORGAN",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2655-035",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003841",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38597500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIMOTHY",
            "last_name": "CORGAN",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Julie R Conley, PHYSICAL THERAPIST
• Mitchell C Connell, LPC
• Lisa R Cook, NP
• Robert James Cooper, CRNA
• Corgan Vision Clinic, S.C.
• Cornerstone Caregiving East LLC
• Cornerstone Christian Counseling LLC
• Robin Corwin, APNP
• Kaitlyn Rose Couillard, PTA
• County of Marinette

• 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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.