MEDICARE: JANICE Y TAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV009213	NY

General Provider Information

NPI Number	:	1053935064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE Y TAN

Provider Business Mailing Address
First Line	:	3808 UNION ST # 3M-L
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5543
Country	:	US
Telephone Number	:	929-666-5048
Fax Number	:	929-666-5049

Provider Business Practice Location Address
First Line	:	3808 UNION ST # 3M-L
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5543
Country	:	US
Telephone Number	:	929-666-5048
Fax Number	:	929-666-5049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	01/22/2024

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Directions to “ JANICE Y TAN ” Practice Location

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