Provider Demographics
NPI:1841393733
Name:WILLIAM R. TANNER, O.D., INC.
Entity Type:Organization
Organization Name:WILLIAM R. TANNER, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-339-6016
Mailing Address - Street 1:231 BLUEBELL DR. NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663
Mailing Address - Country:US
Mailing Address - Phone:330-339-6016
Mailing Address - Fax:330-339-6434
Practice Address - Street 1:2419 BAIRD AVE NE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:OH
Practice Address - Zip Code:44669-9656
Practice Address - Country:US
Practice Address - Phone:330-862-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3972/T679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU-08716Medicare UPIN