Provider Demographics
NPI:1437308871
Name:TAM, JOANNA (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:TAM
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 1:5345 WINTHROP AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3278
Mailing Address - Country:US
Mailing Address - Phone:317-721-2154
Mailing Address - Fax:
Practice Address - Street 1:5345 WINTHROP AVE
Practice Address - Street 2:SUITE D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3278
Practice Address - Country:US
Practice Address - Phone:317-721-2154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003550A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist