Provider Demographics
NPI:1730220211
Name:TANNEN, BARRY (OD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:TANNEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 KUSER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3703
Mailing Address - Country:US
Mailing Address - Phone:609-581-5755
Mailing Address - Fax:609-581-7055
Practice Address - Street 1:1777 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3703
Practice Address - Country:US
Practice Address - Phone:609-581-5755
Practice Address - Fax:609-581-7055
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4203152WV0400X
NJ27OA00431000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521680OtherMEDICARE GROUP
NJT77694Medicare UPIN
NJ720136BEYMedicare PIN