MEDICARE: TARA NOELLE FONTANA

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	156FX1800X	Optician	LDO003261	AZ

General Provider Information

NPI Number	:	1285576157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA NOELLE FONTANA

Provider Business Mailing Address
First Line	:	3126 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4502
Country	:	US
Telephone Number	:	602-957-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	3126 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4502
Country	:	US
Telephone Number	:	602-957-1716
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ TARA NOELLE FONTANA ” Practice Location

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