Provider Demographics
NPI:1215195201
Name:STANLEY, TARA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:SARNOWSKI-STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1060 W. PERIMETER ROAD
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:240-612-1800
Mailing Address - Fax:
Practice Address - Street 1:1060 W PERIMETER RD
Practice Address - Street 2:
Practice Address - City:JB ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762-6602
Practice Address - Country:US
Practice Address - Phone:240-612-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist