Provider Demographics
NPI:1225000466
Name:JAMES A TAMMARO MD PC
Entity Type:Organization
Organization Name:JAMES A TAMMARO MD PC
Other - Org Name:EYES OF ARIZONA VISION AND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAMMARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-855-9477
Mailing Address - Street 1:40 CAPRI BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5661
Mailing Address - Country:US
Mailing Address - Phone:928-855-9477
Mailing Address - Fax:928-855-1799
Practice Address - Street 1:40 CAPRI BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5661
Practice Address - Country:US
Practice Address - Phone:928-855-9477
Practice Address - Fax:928-855-1799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES A TAMMARO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-02
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-08778332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0200500OtherBCBS
AZ077182Medicaid
AZ49001705Medicare PIN
AZ0587720005Medicare NSC