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General NPI Number Information
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NPI Number | 1730430471
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Entity Type | Organization
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Legal Business Name | MAI TANG OD INC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 12300 SEAL BEACH BLVD
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City | SEAL BEACH
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State | CA
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Zip | 90740-2709
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Country | US
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Telephone | 714-924-2552
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Fax | 562-594-8416
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Provider Business Mailing Address
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Address Line | 5365 GRANBY DR
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City | YORBA LINDA
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State | CA
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Zip | 92887-3712
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Country | US
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Telephone | 714-924-2552
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Fax | 562-594-8416
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAI TANG
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Credential | O.D
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Telephone | 714-924-2552
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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 | 10595T
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License Number State | CA
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