Individual
MS. TARA JANE NATHANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
136 S MAIN ST, EATON RAPIDS, MI 48827-1068
(517) 663-2020
Mailing address
409 OTTAWA DR, OSCODA, MI 48750-1430
(989) 335-0320
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004734
MI
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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