Provider Demographics
NPI:1386027407
Name:TAM, KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:TAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14224 BERNABE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3405
Mailing Address - Country:US
Mailing Address - Phone:510-918-9951
Mailing Address - Fax:
Practice Address - Street 1:2015 BIRCH RD STE 1019
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2011
Practice Address - Country:US
Practice Address - Phone:619-397-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist