Provider Demographics
NPI:1003320136
Name:TAO, CLARE (OD)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:TAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MCWILLIAMS PL APT 204
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1649
Mailing Address - Country:US
Mailing Address - Phone:718-808-3811
Mailing Address - Fax:
Practice Address - Street 1:6000 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1448
Practice Address - Country:US
Practice Address - Phone:201-854-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008709152W00000X
NJ27OA00685000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty