Individual
DR. TARA LEANNE DEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
59 VETERANS MEMORIAL DR, STE. B, KOSCIUSKO, MS 39090-3433
(662) 289-1067
Mailing address
PO BOX 778, KOSCIUSKO, MS 39090-0778
(662) 289-1067
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
776
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04501384
—
MS
Enumeration date
07/29/2007
Last updated
01/22/2008
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