MEDICARE: CALEB KAI-HAY TAN OD

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	2677	AZ

General Provider Information

NPI Number	:	1891495883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB KAI-HAY TAN OD

Provider Business Mailing Address
First Line	:	6795 E CALLE LA PAZ UNIT 11201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-9043
Country	:	US
Telephone Number	:	510-209-6209
Fax Number	:

Provider Business Practice Location Address
First Line	:	7204 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1407
Country	:	US
Telephone Number	:	520-416-7476
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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