Provider Demographics
NPI:1194855288
Name:TAN, CATHERINE Y (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:Y
Last Name:TAN
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 1:235 N EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2805
Mailing Address - Country:US
Mailing Address - Phone:760-230-6678
Mailing Address - Fax:760-230-6758
Practice Address - Street 1:235 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2805
Practice Address - Country:US
Practice Address - Phone:760-230-6678
Practice Address - Fax:760-230-6758
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11803OtherMES VISION
CAOP2483OtherEYEMED
CAOP2483OtherEYEMED