| Thomas Eric Herzog Inc | |
|
W7164 Green Valley Rd Spooner WI 54801-6605 | |
| (715) 635-3127 | |
| (715) 635-3316 |
| Full Name | Thomas Eric Herzog Inc |
|---|---|
| Speciality | Clinic/center |
| Location | W7164 Green Valley Rd, Spooner, Wisconsin |
| Authorized Official Name and Position | Thomas Eric Herzog (OPTICIAN/OWNER) |
| Authorized Official Contact | 7156353127 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas Eric Herzog Inc Po Box 446 Spooner WI 54801-0446 Ph: (715) 635-3127 | Thomas Eric Herzog Inc W7164 Green Valley Rd Spooner WI 54801-6605 Ph: (715) 635-3127 |
| NPI Number | 1902887508 |
|---|---|
| Provider Enumeration Date | 11/10/2005 |
| Last Update Date | 01/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902887508 | NPI | - | NPPES |
| DG1708 | Other | WI | PALMETTO RR MEDICARE |
| 38711400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
St Mary's Hospital Of Superior Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1180 Chandler Drive, Spooner, WI 54801 Phone: 715-635-2151 |