Healthcare Provider Details

I. General information

NPI: 1699218644
Provider Name (Legal Business Name): DR TERRY TSANG OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 BARRANCA PKWY SUITE A
IRVINE CA
92604-4672
US

IV. Provider business mailing address

4920 BARRANCA PKWY SUITE A
IRVINE CA
92604-4672
US

V. Phone/Fax

Practice location:
  • Phone: 949-870-2763
  • Fax:
Mailing address:
  • Phone: 949-870-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number190789T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number10789T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number10789T
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number10789T
License Number StateCA

VIII. Authorized Official

Name: DR. TERRY TSANG
Title or Position: PRESIDENT
Credential: OD
Phone: 949-870-6723