Individual
JAY B TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
423 3RD AVE, SUITE E, KINGSTON, PA 18704-5809
(570) 288-1974
(570) 288-0288
Mailing address
423 3RD AVE, SUITE E, KINGSTON, PA 18704-5809
(570) 288-1974
(570) 288-0288
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG 000400
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011040000003
—
PA
05
—
0011040000005
—
PA
01
—
410043623
PALMETTO GBA-RRMC
PA
Enumeration date
07/26/2005
Last updated
04/29/2020
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