Provider Demographics
NPI:1205897030
Name:TARLE, IVAN (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:TARLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1432
Mailing Address - Country:US
Mailing Address - Phone:407-893-8200
Mailing Address - Fax:407-893-8220
Practice Address - Street 1:1911 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1432
Practice Address - Country:US
Practice Address - Phone:407-893-8200
Practice Address - Fax:407-893-8220
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75834207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
400984OtherGHI
FL5581013OtherAETNA PPO/POS
FL1036804OtherCIGNA
FL1290944OtherUNITED HEALTH CARE
FL26216900Medicaid
FL151706765OtherTRI CARE
FL26999OtherBCBS
FL547OtherWELL CARE
FL2083692OtherAETNAHMO
FL2083692OtherAETNAHMO
FL547OtherWELL CARE
FL26999OtherBCBS