Provider Demographics
NPI:1588645956
Name:WARMOUTH, TAMMY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:WARMOUTH
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 1:73 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1201
Mailing Address - Country:US
Mailing Address - Phone:570-283-0870
Mailing Address - Fax:570-283-2309
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1201
Practice Address - Country:US
Practice Address - Phone:570-283-0870
Practice Address - Fax:570-283-2309
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA61104OtherGEISINGER
PA837336OtherAETNA HMO
PA5735329OtherAETNA PPO
PA7686PAOtherVBA
PA7217744Medicaid
PA807807OtherFIRST PRIORITY
U54285Medicare UPIN
PAWA602665Medicare ID - Type Unspecified