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General NPI Number Information
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NPI Number | 1144928540
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Entity Type | Individual
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Provider Name | SANDRA JEAN TIERNEY
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Gender | Female
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | WALMART 1275 E 2ND STREET
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City | FRANKLIN
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State | OH
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Zip | 45005
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Country | US
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Telephone | 937-704-0809
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Fax | 937-704-0820
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Provider Business Mailing Address
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Address Line | 1947 MEADOWSWEET DR
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City | LEBANON
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State | OH
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Zip | 45036-4077
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Country | US
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Telephone | 419-654-4138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | OP.017188-SC
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License Number State | OH
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