=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699077230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RETINA EYE CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2010
-----------------------------------------------------
Last Update Date | 12/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 182 W CENTRAL ST SUITE 102
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-3756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-903-0003
-----------------------------------------------------
Fax | 508-903-0005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 W CENTRAL ST SUITE 102
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-3756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-903-0003
-----------------------------------------------------
Fax | 508-903-0005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM MANSING TANG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 508-903-0003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 153637
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------