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General NPI Number Information
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NPI Number | 1003104035
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Entity Type | Organization
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Legal Business Name | LAUREN NGHIA TANG, O.D. INC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 10440 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1812
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Country | US
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Telephone | 951-353-2020
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Fax | 951-637-1858
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Provider Business Mailing Address
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Address Line | 848 SAN DIEGO LN
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City | PLACENTIA
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State | CA
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Zip | 92870-6219
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAUREN NGHIA TANG
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Credential | O.D.
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Telephone | 714-721-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12624T
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License Number State | CA
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