MEDICARE: KRISTIN B TALLMAN 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
1	152W00000X	Optometrist	3841	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083697361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN B TALLMAN O.D.

Provider Business Mailing Address
First Line	:	360 MERRIMACK ST
Second Line	:	BLDG 9, ENTRANCE I
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1740
Country	:	US
Telephone Number	:	978-688-6182
Fax Number	:	978-689-0731

Provider Business Practice Location Address
First Line	:	360 MERRIMACK ST
Second Line	:	BLDG 9, ENTRANCE I
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1740
Country	:	US
Telephone Number	:	978-688-6182
Fax Number	:	978-689-0731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	11/25/2013

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