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General NPI Number Information
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NPI Number | 1497528129
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Entity Type | Organization
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Legal Business Name | TAY VISION CENTERS O.D. INC
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 4433 S ALAMEDA ST UNIT C12
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City | LOS ANGELES
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State | CA
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Zip | 90058-2008
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Country | US
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Telephone | 323-988-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 4433 S ALAMEDA ST UNIT C12
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City | LOS ANGELES
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State | CA
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Zip | 90058-2008
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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 | OPTOMETRIST
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Name | MICHAEL TAY
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Credential | OD
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Telephone | 603-867-2269
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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 |
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License Number State |
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