Provider Demographics
NPI:1376594556
Name:MORRIS, TAMARA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:ANN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:ANN
Other - Last Name:GRAMMER MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:594 E MILLSAP RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4096
Mailing Address - Country:US
Mailing Address - Phone:479-442-2020
Mailing Address - Fax:479-521-3988
Practice Address - Street 1:594 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4096
Practice Address - Country:US
Practice Address - Phone:479-442-2020
Practice Address - Fax:479-521-3988
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125891722Medicaid
AR48814Medicare ID - Type Unspecified
U51153Medicare UPIN