MEDICARE: DR. KRISTEN JEAN TADDIE 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	TUV007736	NY

General Provider Information

NPI Number	:	1831483585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN JEAN TADDIE O.D.

Provider Business Mailing Address
First Line	:	5100 W TAFT RD
Second Line	:	STE 4M
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-3810
Country	:	US
Telephone Number	:	315-455-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 LAWRENCE RD E
Second Line	:
City	:	N SYRACUSE
State	:	NY
Zip	:	13212-3844
Country	:	US
Telephone Number	:	315-455-5500
Fax Number	:

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

Provider Enumeration Date	:	05/29/2011
Last Update Date	:	10/31/2016

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