Provider Demographics
NPI:1003671363
Name:HUNDLEY, TARI SUSAN (COA)
Entity Type:Individual
Prefix:
First Name:TARI
Middle Name:SUSAN
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 E RIVER RD APT 23
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2682
Mailing Address - Country:US
Mailing Address - Phone:513-280-1541
Mailing Address - Fax:
Practice Address - Street 1:2929 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2463
Practice Address - Country:US
Practice Address - Phone:513-559-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant