MEDICARE: DR. TIA MARIE TUCKER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5982	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134434350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIA MARIE TUCKER O.D.

Provider Business Mailing Address
First Line	:	4240 SECOR RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4238
Country	:	US
Telephone Number	:	419-475-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 SECOR RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4238
Country	:	US
Telephone Number	:	419-475-6605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	12/20/2016

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