Provider Demographics
NPI:1174672992
Name:SHRINER, TAMARA A (OD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:SHRINER
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 1:834 S CANAL RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-9644
Mailing Address - Country:US
Mailing Address - Phone:517-627-6179
Mailing Address - Fax:
Practice Address - Street 1:5726 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2457
Practice Address - Country:US
Practice Address - Phone:517-327-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34030006Medicare ID - Type Unspecified
MIU44807Medicare UPIN