Provider Demographics
NPI:1194004788
Name:LAI, TIFFANNY N (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANNY
Middle Name:N
Last Name:LAI
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 1:10717 NEW BORO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4405
Mailing Address - Country:US
Mailing Address - Phone:408-472-7088
Mailing Address - Fax:
Practice Address - Street 1:2021 N RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-7098
Practice Address - Country:US
Practice Address - Phone:702-452-2020
Practice Address - Fax:702-437-5502
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14236152W00000X
NV1110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist