NPI Code Detail JSON Logo

1609227222 NPI number — CONNIE TAN O.D.

NPI Number: 1609227222
Health Care Provider/Practitioner: CONNIE TAN O.D.

Information about “1609227222” NPI (CONNIE TAN O.D.) exists in 1609227222 in HTML format HTML  |  1609227222 in plain Text format TXT  |  1609227222 in PDF (Portable Document Format) PDF  |  1609227222 in an XML format XML  formats.

NPI Number : 1609227222 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609227222",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAN",
    "FirstName": "CONNIE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7637 HEATHERLY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92130-5602",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-569-3780",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "477 N EL CAMINO REAL STE C202",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ENCINITAS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92024-1332",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-631-3500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2016",
    "LastUpdateDate": "07/15/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "08446",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "33425",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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