Provider Demographics
NPI:1952347932
Name:RICHARD C TAM MD & CHRISTINA P TAM MD LLC
Entity Type:Organization
Organization Name:RICHARD C TAM MD & CHRISTINA P TAM MD LLC
Other - Org Name:WOOD COUNTY EYE & GLAUCOMA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-878-2180
Mailing Address - Street 1:8450 SNAPDRAGON LN
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9617
Mailing Address - Country:US
Mailing Address - Phone:419-878-2180
Mailing Address - Fax:
Practice Address - Street 1:970 W WOOSTER ST
Practice Address - Street 2:SUITE #224
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2643
Practice Address - Country:US
Practice Address - Phone:419-352-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2532174Medicaid
OH=========OtherWOOD CARE NET GROUP
OH=========-00OtherBWC GROUP
OH2532174Medicaid
OH2532174Medicaid