Provider Demographics
NPI:1922125376
Name:TARTAGLIA, LOUIS M (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:M
Last Name:TARTAGLIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4514 LA CUENTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3009
Mailing Address - Country:US
Mailing Address - Phone:858-278-3907
Mailing Address - Fax:
Practice Address - Street 1:13487 CAMINO CANADA
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8811
Practice Address - Country:US
Practice Address - Phone:619-390-4594
Practice Address - Fax:619-390-4592
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12019OtherMES
CA51088OtherSAFEGUARD