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NPI Code Detail

MEDICARE: DR. CARINE MUNGO TATA OD

MEDICARE: DR. CARINE MUNGO TATA OD
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
1152W00000XOptometristI3-0001410DE

General Provider Information

NPI Number : 1821591355
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARINE MUNGO TATA OD
Provider Business Mailing Address
First Line : 1950 OLD GALLOWS RD STE 520
Second Line :
City : VIENNA
State : VA
Zip : 22182-3970
Country : US
Telephone Number : 703-847-8899
Fax Number : 866-795-4020
Provider Business Practice Location Address
First Line : 1237 QUINTILIO DR
Second Line :
City : BEAR
State : DE
Zip : 19701-6005
Country : US
Telephone Number : 302-838-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2018
Last Update Date : 10/31/2019

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