Provider Demographics
NPI:1396136727
Name:TARESSA, MERON
Entity type:Individual
Prefix:MS
First Name:MERON
Middle Name:
Last Name:TARESSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S PICKETT ST
Mailing Address - Street 2:SUITE #29
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7207
Mailing Address - Country:US
Mailing Address - Phone:571-421-9094
Mailing Address - Fax:703-567-0384
Practice Address - Street 1:50 S PICKETT ST
Practice Address - Street 2:SUITE #29
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7207
Practice Address - Country:US
Practice Address - Phone:571-421-9094
Practice Address - Fax:703-567-0384
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician