CARLSON TILLISCH EYE CLINIC, LTD (NPI# 1225116932) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225116932 |
| Entity Type | Organization |
| Organization Name | CARLSON TILLISCH EYE CLINIC, LTD |
| Practice Address |
120 N Broad St Mankato MN 56001-3518 |
| Mailing Address |
Po Box 3387 Mankato MN 56002-3387 |
| Practice Telephone | 5073455087 |
| Practice Fax Number | 5073451151 |
| Mailing Telephone | 5073455087 |
| Mailing Fax Number | 5073451151 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2018-11-05 |
| Authorized Official Name | DR. GEORGE JOHN LACH (OWNER) |
| Authorized Official Telephone | 5073455087 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS & BLUE SHIELD | 41663TI | 01 |
| MN | MEDICAL ASSISTANCE | 960103100 | 01 |
| Street Address |
120 N BROAD ST |
| City | MANKATO |
| State | MN |
| Zip Code | 56001-3518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935435 | Kelly Nicole Ricke | Physical Medicine & Rehabilitation | 1 Civic Center Plaza, Hockey Office Complex, Mankato, MN 56001 | 2020-09-03 |
| 1649816786 | Ashley Lynn Walters | Technician, Other | 501 Madison Ave., Mankato, MN 56001 | 2019-11-25 |
| 1720631716 | Dovetail Traslation LLC | Interpreter | 212 Dublin Ct, Same As Above, Mankato, MN 56001 | 2019-07-19 |
| 1093377871 | Lindsey Keithahn | Counselor | 2100 Bassett Drive, Mankato, MN 56001 | 2019-07-02 |
| 1255803813 | Amy Marie Williams | Acupuncturist | 709 S. Front Street, Suite 5, Mankato, MN 56001 | 2018-12-20 |
| 1518437573 | Ashley Blanchard | Acupuncturist | Vida Salon Suites 1351 Madison Avenue, Suite F/ Suite 206, Mankato, MN 56001 | 2018-12-03 |
| 1831687235 | Christian Goetz | Specialist/Technologist | 401-477 South Rd, Mankato, MN 56001 | 2018-05-01 |
| 1366949141 | Minnesota State College and Universities | Specialist/Technologist | 135 Myers Field House, Mankato, MN 56001 | 2018-04-09 |
| 1780191775 | Kevin David Nelson | Pharmacist | 111 Redtail Ct Apt 308, Mankato, MN 56001 | 2017-12-29 |
| 1972014231 | Rylee Wagner | Speech-Language Pathologist | Mankato Clinic Pediatric Therapy Services, 150 St. Andrews Court, Suite 310, Mankato, MN 56001 | 2017-10-13 |
| Find all providers in zip 56001 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215091723 | Michael Jackson | Optometrist | 1850 Adams St Ste 112, Mankato, MN 56001-4846 | 2006-12-20 |
| 1891862231 | Thomas Warner Dull | Optometrist | 1850 Adam St Suite 005 Sears Optical, Thomas W Dull, Mankato, MN 56001 | 2006-11-29 |
| 1811075401 | Jean M Tasler | Optometrist | 1819 Adams St, Mankato, MN 56001-4841 | 2006-11-01 |
| 1316974967 | Dale L Carlson | Optometrist | 220 East Main, Mankato, MN 56002-3387 | 2006-06-27 |
| 1467404210 | Rachael Suzanne Potter | Optometrist | 1820 E Madison Ave, Mankato, MN 56001-5448 | 2006-05-17 |
| 1386626794 | Albert Ray Lamotte | Optometrist | 111 Star St, Suite 101, Mankato, MN 56001-4888 | 2005-11-20 |
| 1376049031 | Murphy Grotewold | Optometrist | 220 E Main St, Mankato, MN 56001 | 2018-04-02 |
| 1790149003 | Laura Goemann | Optometrist | 1400 Madison Ave Ste 338, Mankato, MN 56001-5465 | 2016-04-12 |
| 1447586987 | Nathaniel Lee Graham | Optometrist | 1421 Premier Dr, Mankato, MN 56001-6076 | 2009-10-18 |
| 1538398250 | Angela Michelle Johnson | Optometrist | 1400 E Madison Ave, Suite 338, Mankato, MN 56001-5473 | 2009-07-02 |
| Find all providers in MANKATO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.