Provider Demographics
NPI:1295733798
Name:PANNER, TAMMY JANE (OD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JANE
Last Name:PANNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8140 ASHTON AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5699
Mailing Address - Country:US
Mailing Address - Phone:703-361-8284
Mailing Address - Fax:703-361-0318
Practice Address - Street 1:8140 ASHTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5699
Practice Address - Country:US
Practice Address - Phone:703-361-8284
Practice Address - Fax:703-361-0318
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63461Medicare UPIN
0244380001Medicare NSC
410036423Medicare PIN
VA410000964Medicare PIN