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NPI Code Detail

MEDICARE: TAMMY BAIN

MEDICARE: TAMMY BAIN
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
1156FX1800XOpticianDO6847FL

General Provider Information

NPI Number : 1235821612
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY BAIN
Provider Business Mailing Address
First Line : 6868 US HIGHWAY 129
Second Line :
City : LIVE OAK
State : FL
Zip : 32060-8476
Country : US
Telephone Number : 386-330-2498
Fax Number : 386-330-2592
Provider Business Practice Location Address
First Line : 6868 US HIGHWAY 129
Second Line :
City : LIVE OAK
State : FL
Zip : 32060-8476
Country : US
Telephone Number : 386-330-2498
Fax Number : 386-330-2592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2023
Last Update Date : 05/23/2023

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Directions to “ TAMMY BAIN ” Practice Location

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