Provider Demographics
NPI:1972115764
Name:MCDANIEL, TARYN EILEEN (OD)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:EILEEN
Last Name:MCDANIEL
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 1:9034 N DEER FIELD LN
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-9719
Mailing Address - Country:US
Mailing Address - Phone:219-816-1729
Mailing Address - Fax:
Practice Address - Street 1:1601 E 80TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5737
Practice Address - Country:US
Practice Address - Phone:219-750-9673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004242A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist