Provider Demographics
NPI:1265662381
Name:LASATER, TARAN L (OD)
Entity type:Individual
Prefix:
First Name:TARAN
Middle Name:L
Last Name:LASATER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TARAN
Other - Middle Name:L
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:336 SW CYBER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1684
Mailing Address - Country:US
Mailing Address - Phone:541-382-5701
Mailing Address - Fax:
Practice Address - Street 1:336 SW CYBER DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1684
Practice Address - Country:US
Practice Address - Phone:541-382-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2607152W00000X
ORATI4667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA101673OtherPTAN