Healthcare Provider Details

I. General information

NPI: 1598928715
Provider Name (Legal Business Name): TAWNY KAEOCHINDA FANNING O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE OPHTHALMOLOGY CLINIC
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE OPHTHALMOLOGY CLINIC
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3419
  • Fax:
Mailing address:
  • Phone: 760-719-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number13521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: