MEDICARE: TAY VISION CENTERS O.D. INC

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

General Provider Information

NPI Number	:	1497528129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAY VISION CENTERS O.D. INC

Provider Business Mailing Address
First Line	:	4433 S ALAMEDA ST UNIT C12
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90058-2008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 S ALAMEDA ST UNIT C12
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90058-2008
Country	:	US
Telephone Number	:	323-988-1033
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MICHAEL TAY
Credential	:	OD
Telephone Number	:	603-867-2269

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	11/03/2023

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