Provider Demographics
NPI:1144238890
Name:TAFFORA, JAMIE (OD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TAFFORA
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 1:1206 ORISKANY DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3099
Mailing Address - Country:US
Mailing Address - Phone:219-365-3735
Mailing Address - Fax:219-756-0560
Practice Address - Street 1:303 W 89TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6294
Practice Address - Country:US
Practice Address - Phone:219-769-8989
Practice Address - Fax:219-756-0560
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046-009004OtherLICENSED OPTOMETRIST NUMB