MEDICARE: DR. TAWNY KAEOCHINDA FANNING 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	152WC0802X	Corneal and Contact Management Optometrist	13521	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CB221880	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12390980	OTHER		CAQH

General Provider Information

NPI Number	:	1598928715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAWNY KAEOCHINDA FANNING O.D.

Provider Business Mailing Address
First Line	:	200 MERCY CIRCLE
Second Line	:	OPHTHALMOLOGY CLINIC
City	:	CAMP PENDLETON
State	:	CA
Zip	:	92055
Country	:	US
Telephone Number	:	760-719-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MERCY CIRCLE
Second Line	:	OPHTHALMOLOGY CLINIC
City	:	CAMP PENDLETON
State	:	CA
Zip	:	92055
Country	:	US
Telephone Number	:	760-719-3419
Fax Number	:

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	04/22/2026

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