Provider Demographics
NPI:1508096512
Name:FESTA, TARA SMITH (OD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SMITH
Last Name:FESTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 STATE FARM PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7181
Mailing Address - Country:US
Mailing Address - Phone:205-943-4650
Mailing Address - Fax:205-943-4688
Practice Address - Street 1:3290 DAUPHIN ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4053
Practice Address - Country:US
Practice Address - Phone:251-471-3309
Practice Address - Fax:251-471-5046
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020664152W00000X
ALSC26TA845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist