Provider Demographics
NPI:1972529428
Name:TARR, BLANE L (OD)
Entity Type:Individual
Prefix:DR
First Name:BLANE
Middle Name:L
Last Name:TARR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2930
Mailing Address - Country:US
Mailing Address - Phone:423-623-2020
Mailing Address - Fax:423-623-3937
Practice Address - Street 1:115 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2930
Practice Address - Country:US
Practice Address - Phone:423-623-2020
Practice Address - Fax:423-623-3937
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2654152W00000X
KY1682DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I413388Medicare PIN