Provider Demographics
NPI:1740381623
Name:DEVLIN, TANYA (OD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:DEVLIN
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:PO BOX 185
Mailing Address - Street 2:182 GROVE STREET
Mailing Address - City:MIDDLEBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12122-0185
Mailing Address - Country:US
Mailing Address - Phone:518-827-4818
Mailing Address - Fax:
Practice Address - Street 1:139 MERCHANT PL
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5715
Practice Address - Country:US
Practice Address - Phone:518-234-1155
Practice Address - Fax:518-254-0691
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist