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General NPI Number Information
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NPI Number | 1376828756
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Entity Type | Individual
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Provider Name | VI TAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 1201 LAKE WOODLANDS DR SUITE 300
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City | SPRING
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State | TX
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Zip | 77380-5000
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Country | US
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Telephone | 281-292-2720
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Fax | 281-362-0442
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Provider Business Mailing Address
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Address Line | 1201 LAKE WOODLANDS DR SUITE 300
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City | SPRING
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State | TX
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Zip | 77380-5000
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Country | US
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Telephone | 281-292-2720
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Fax | 281-362-0442
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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 | 7874TG
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License Number State | TX
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