=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457575722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE TANG O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 01/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1673 BRANHAM LANE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-269-6861
-----------------------------------------------------
Fax | 857-364-6092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1673 BRANHAM LANE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-269-6861
-----------------------------------------------------
Fax | 857-364-6092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 13446TLG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4365
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------