Healthcare Provider Details

I. General information

NPI: 1518895994
Provider Name (Legal Business Name): AUDREY WINGHEI TAM OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NORTHSHORE DR
RICHMOND CA
94804-2541
US

IV. Provider business mailing address

2106 NORTHSHORE DR
RICHMOND CA
94804-2541
US

V. Phone/Fax

Practice location:
  • Phone: 415-439-3155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: