1033112552 NPI number — DR. ROBERT CHARLES TARR O.D.

Table of content: DR. ROBERT CHARLES TARR O.D. (NPI 1033112552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033112552 NPI number — DR. ROBERT CHARLES TARR O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARR
Provider First Name:
ROBERT
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033112552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22952 VIA MIRAMAR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA NIGUEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92677-2751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-487-9169
Provider Business Mailing Address Fax Number:
949-487-1644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25982 PALA
Provider Second Line Business Practice Location Address:
STE 270
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-770-5514
Provider Business Practice Location Address Fax Number:
949-770-5471
Provider Enumeration Date:
05/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 5953 TPA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SD0059530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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