Provider Demographics
NPI:1275591265
Name:TANADA, JULIET TAEKO (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIET
Middle Name:TAEKO
Last Name:TANADA
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:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - Street 2:ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:DE
Mailing Address - Phone:01149637-186-8839
Mailing Address - Fax:01149637-186-6133
Practice Address - Street 1:USAHC BAUMHOLDER
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09034
Practice Address - Country:DE
Practice Address - Phone:0114967-836-6640
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3155152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics