Provider Demographics
NPI:1932514981
Name:KAYS, TARA LYNN (OD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:KAYS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:BUCKLEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:939 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1127
Mailing Address - Country:US
Mailing Address - Phone:610-434-1000
Mailing Address - Fax:610-434-9592
Practice Address - Street 1:740 W HAMILTON ST STE 100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-2425
Practice Address - Country:US
Practice Address - Phone:610-434-1000
Practice Address - Fax:610-434-9592
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103131626-0001Medicaid
PA643210142OtherMEDICARE DCN/CCN