Provider Demographics
NPI:1467561084
Name:TAN, TIENG MENG (OD)
Entity Type:Individual
Prefix:DR
First Name:TIENG
Middle Name:MENG
Last Name:TAN
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 1:5531 E STEARNS ST STE A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3125
Mailing Address - Country:US
Mailing Address - Phone:626-827-9078
Mailing Address - Fax:
Practice Address - Street 1:220 W VALLEY BLVD
Practice Address - Street 2:202
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3738
Practice Address - Country:US
Practice Address - Phone:626-827-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX104YMedicare PIN