Healthcare Provider Details

I. General information

NPI: 1841393733
Provider Name (Legal Business Name): WILLIAM R. TANNER, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 BAIRD AVE NE
PARIS OH
44669-9656
US

IV. Provider business mailing address

231 BLUEBELL DR. NW
NEW PHILADELPHIA OH
44663
US

V. Phone/Fax

Practice location:
  • Phone: 330-862-2241
  • Fax:
Mailing address:
  • Phone: 330-339-6016
  • Fax: 330-339-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3972/T679
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM R. TANNER
Title or Position: DOCTOR OF OPTOMETRY
Credential: O.D.
Phone: 330-339-6016