MEDICARE: DR. CHING MAN TANG O.D

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	TUV007562-1	NY

General Provider Information

NPI Number	:	1063726859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHING MAN TANG O.D

Provider Business Mailing Address
First Line	:	302C LIBERTY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2243
Country	:	US
Telephone Number	:	646-346-9072
Fax Number	:

Provider Business Practice Location Address
First Line	:	2935 VETERANS RD W STE D
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2514
Country	:	US
Telephone Number	:	718-967-2869
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/11/2010

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