Healthcare Provider Details

I. General information

NPI: 1730247909
Provider Name (Legal Business Name): TARA M MCNAMARA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 VINE ST
MIDDLETOWN PA
17057-3565
US

IV. Provider business mailing address

4000 VINE ST
MIDDLETOWN PA
17057-3565
US

V. Phone/Fax

Practice location:
  • Phone: 717-944-9814
  • Fax: 717-944-9814
Mailing address:
  • Phone: 717-944-9814
  • Fax: 717-944-9814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG001416
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTOO6072-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: