Provider Demographics
NPI:1316901366
Name:RANSDELL, TARA HECHT (OD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:HECHT
Last Name:RANSDELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 W DEER VALLEY RD STE E200
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7430
Mailing Address - Country:US
Mailing Address - Phone:623-376-9070
Mailing Address - Fax:623-376-9079
Practice Address - Street 1:7727 W DEER VALLEY RD STE E200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7430
Practice Address - Country:US
Practice Address - Phone:623-376-9070
Practice Address - Fax:623-376-9079
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ114149Medicare PIN
AZZ114148Medicare PIN
AZU81050Medicare UPIN