Basic Information
| Provider Information | |||||||||
| NPI: | 1912437146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAI | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | JUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10967 ALLISONVILLE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460382634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175770707 | ||||||||
| FaxNumber: | 3175771567 | ||||||||
| Practice Location | |||||||||
| Address1: | 10967 ALLISONVILLE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175770707 | ||||||||
| FaxNumber: | 3175771567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 09/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18004020A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.