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General NPI Number Information
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NPI Number | 1053935064
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Entity Type | Individual
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Provider Name | JANICE Y TAN
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Gender | Female
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 3808 UNION ST # 3M-L
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City | FLUSHING
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State | NY
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Zip | 11354-5543
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Country | US
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Telephone | 929-666-5048
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Fax | 929-666-5049
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Provider Business Mailing Address
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Address Line | 3808 UNION ST # 3M-L
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City | FLUSHING
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State | NY
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Zip | 11354-5543
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Country | US
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Telephone | 929-666-5048
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Fax | 929-666-5049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV009213
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License Number State | NY
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