Provider Demographics
NPI:1083825772
Name:DONOVAN, TARA (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 FISCHER RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2084
Mailing Address - Country:US
Mailing Address - Phone:770-304-8613
Mailing Address - Fax:
Practice Address - Street 1:310 FISCHER RD
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2084
Practice Address - Country:US
Practice Address - Phone:770-304-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist