Provider Demographics
NPI:1518645183
Name:TATHAM, OLEN THOMAS III (OD)
Entity Type:Individual
Prefix:
First Name:OLEN
Middle Name:THOMAS
Last Name:TATHAM
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-258-1586
Mailing Address - Fax:828-210-0962
Practice Address - Street 1:1196 SKYLAND DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8002
Practice Address - Country:US
Practice Address - Phone:828-258-1586
Practice Address - Fax:828-210-0962
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2429152W00000X
NC2769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty