Carlson Tillisch Eye Clinic, LTD

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

CARLSON TILLISCH EYE CLINIC, LTD

Practice address

26 N Broadway St
New Ulm, MN 56073-1747

Phone

(507) 354-7407

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Tara Butson

Title

Accounts Manager

Phone

(507) 345-5087

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Carlson Tillisch Eye Clinic, LTD

  • Optometrist
  • Mankato, MN
  • NPI 1225116932

  3072410521

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Carlson Tillisch Eye Clinic, LTD

  • Optometrist
  • Mankato, MN
  • NPI 1225116932

  O20031215000301

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Carlson Tillisch Eye CL LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Carlson Tillisch Eye Clinic, LTD

  • Optometrist
  • Mankato, MN
  • NPI 1225116932
  NPD tax ID

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew R Downs, OD

  • Optometrist
  • Mankato, MN
  • NPI 1205857042
  NPD
• Bridget Sue Forstrom, O.D.

  • Optometrist
  • Saint James, MN
  • NPI 1649470618
  NPD
• Murphy Grotewold

  • Optometrist
  • Mankato, MN
  • NPI 1376049031
  NPD
• George John Lach Jr., O.D.

  • Optometrist
  • Mankato, MN
  • NPI 1609826577
  NPD
• Adam Peters, OD

  • Optometrist
  • Marshall, MN
  • NPI 1851063952
  NPD
• Tracye Dawn Rasmussen, OD

  • Optometrist
  • Mankato, MN
  • NPI 1982702247
  NPD
• Shawnee Sovell, OD

  • Optometrist
  • Owatonna, MN
  • NPI 1740718626
  NPD

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1821159435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 156",
            "city": "NEW ULM",
            "state": "MN",
            "postal_code": "560730156",
            "telephone_number": "507-354-7407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 N BROADWAY ST",
            "city": "NEW ULM",
            "state": "MN",
            "postal_code": "560731747",
            "telephone_number": "507-354-7407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLSON TILLISCH EYE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "BUTSON",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "507-345-5087"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Dawn Bynes, DNP
• Lois Lorraine Byrne, MSW-LICSW
• Ashley Theresa Campbell, PA-C
• Eileen Dee Campbell, PT.
• Hunter Campbell, MSW LGSW
• Rayvin Eilene Carlson
• Veronica Carus, DT
• Adeline Choge, RN
• Mimi Marie Chough, LMFT
• Katie Christina Christianson, LPCC

• Optometrist in New Ulm, MN
• Providers in New Ulm, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.