Provider Demographics
NPI:1336146497
Name:SVATOS, TARA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:SVATOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-0760
Practice Address - Street 1:13197 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-247-1500
Practice Address - Fax:574-247-1505
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410049816OtherMEDICARE RAILROAD
IN000000277906OtherANTHEM BCBS
INP01598940OtherRAILROAD MEDICARE
IN4777440001OtherDME MAC
IN100093180Medicaid
IN4777440001OtherDME MAC
INU44566Medicare UPIN