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NPI Code Detail

MEDICARE: DR. TARA M PAUL O.D.

MEDICARE: DR. TARA M PAUL 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
1152W00000XOptometrist5436 T2347OH

General Provider Information

NPI Number : 1427047893
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARA M PAUL O.D.
Provider Business Mailing Address
First Line : 5955 ZEAMER AVE
Second Line :
City : JBER
State : AK
Zip : 99506-3702
Country : US
Telephone Number : 907-580-1136
Fax Number :
Provider Business Practice Location Address
First Line : 7300 N PERIMETER RD
Second Line :
City : MALMSTROM AFB
State : MT
Zip : 59402-6701
Country : US
Telephone Number : 406-731-6713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 09/30/2022

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Directions to “ DR. TARA M PAUL O.D.” Practice Location

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