Provider Demographics
NPI:1902540107
Name:GONTHIER, TARYN DENISE (OD)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:DENISE
Last Name:GONTHIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:DENISE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:302 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-9481
Mailing Address - Country:US
Mailing Address - Phone:570-574-6315
Mailing Address - Fax:
Practice Address - Street 1:194 BUCKLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8705
Practice Address - Country:US
Practice Address - Phone:860-644-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT3288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program