Provider Demographics
NPI:1982821039
Name:TOZER, TARA KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:KAY
Last Name:TOZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:KAY
Other - Last Name:FORECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:740 TIGRIS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5804
Mailing Address - Country:US
Mailing Address - Phone:407-322-8324
Mailing Address - Fax:407-322-8324
Practice Address - Street 1:1101 RINEHART RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7390
Practice Address - Country:US
Practice Address - Phone:407-302-8708
Practice Address - Fax:407-302-8217
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3860152W00000X
CAOPT11636T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU95571Medicare UPIN
CASD0116360Medicare ID - Type Unspecified