Provider Demographics
NPI:1376828756
Name:TAN, VI (OD)
Entity Type:Individual
Prefix:DR
First Name:VI
Middle Name:
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 1:1201 LAKE WOODLANDS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-5000
Mailing Address - Country:US
Mailing Address - Phone:281-292-2720
Mailing Address - Fax:281-362-0442
Practice Address - Street 1:1201 LAKE WOODLANDS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-5000
Practice Address - Country:US
Practice Address - Phone:281-292-2720
Practice Address - Fax:281-362-0442
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7874TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist