Provider Demographics
NPI:1326013798
Name:TAYLOR, TANAKA (OD)
Entity Type:Individual
Prefix:DR
First Name:TANAKA
Middle Name:
Last Name:TAYLOR
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 1:10223 BROADWAY ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:281-971-9337
Mailing Address - Fax:281-971-9336
Practice Address - Street 1:10223 BROADWAY ST
Practice Address - Street 2:SUITE J
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7880
Practice Address - Country:US
Practice Address - Phone:281-971-9337
Practice Address - Fax:281-971-9336
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6108TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11616024OtherCAQH