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General NPI Number Information
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NPI Number | 1316206550
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Entity Type | Organization
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Legal Business Name | MAI TANG OD, INC
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 10/12/2013
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Provider Practice Location Address
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Address Line | 1893 W MALVERN AVE
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City | FULLERTON
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State | CA
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Zip | 92833-2403
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Country | US
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Telephone | 714-924-2552
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Fax | 714-278-9075
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Provider Business Mailing Address
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Address Line | 5365 GRANBY DR
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City | YORBA LINDA
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State | CA
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Zip | 92887-3712
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Country | US
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Telephone | 714-924-2552
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAI TANG
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Credential | O.D.
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Telephone | 714-924-2552
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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 | 10595T
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License Number State | CA
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