Provider Demographics
NPI:1164457891
Name:MARKIS-MEYER, TANYA DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:DAWN
Last Name:MARKIS-MEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:DAWN
Other - Last Name:MARKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:670 SUTTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5392
Mailing Address - Country:US
Mailing Address - Phone:530-273-6000
Mailing Address - Fax:530-272-8459
Practice Address - Street 1:670 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5392
Practice Address - Country:US
Practice Address - Phone:530-273-6000
Practice Address - Fax:530-272-8459
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10668TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0106680Medicaid
U75589Medicare UPIN
CASD0106681Medicare ID - Type Unspecified