Tillman, Robert E
Tillman, Robert E is an sole proprietor health care provider with primary practice located at 2304 S Main St , Rice Lake WI 54868-2900. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Tillman, Robert E can be contacted via phone (715) 736-1700.Contact Information
Primary practice address
2304 S Main St
Rice Lake WI 54868-2900
Phone: (715) 736-1700
Fax: (715) 736-1703
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1491035 | Wisconsin |
Profile Details
| NPI number | 1457330276 |
|---|---|
| LBN Legal business name | Tillman, Robert E |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 11th, 2006 |
| Last updated | Jan 4th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457330276 | NPPES |
| Wisconsin | MEDICAID | 38563500 |
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