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NPI Code Detail

MEDICARE: WILLIAM R. TANNER, O.D., INC.

MEDICARE: WILLIAM R. TANNER, O.D., INC.
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
1152W00000XOptometrist3972/T679OH

General Provider Information

NPI Number : 1841393733
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIAM R. TANNER, O.D., INC.
Provider Business Mailing Address
First Line : 231 BLUEBELL DR. NW
Second Line :
City : NEW PHILADELPHIA
State : OH
Zip : 44663
Country : US
Telephone Number : 330-339-6016
Fax Number : 330-339-6434
Provider Business Practice Location Address
First Line : 2419 BAIRD AVE NE
Second Line :
City : PARIS
State : OH
Zip : 44669-9656
Country : US
Telephone Number : 330-862-2241
Fax Number :
Authorized Official
Title or Position : DOCTOR OF OPTOMETRY
Name : DR. WILLIAM R. TANNER
Credential : O.D.
Telephone Number : 330-339-6016
Provider Enumeration Date : 09/06/2006
Last Update Date : 12/06/2010

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