Provider Demographics
NPI:1518919562
Name:TANG, KELVIN K (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:K
Last Name:TANG
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LA CASA VIA STE 205
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3008
Mailing Address - Country:US
Mailing Address - Phone:925-938-2020
Mailing Address - Fax:925-938-5050
Practice Address - Street 1:130 LA CASA VIA STE 205
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3008
Practice Address - Country:US
Practice Address - Phone:925-938-2020
Practice Address - Fax:925-938-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12651T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00961Medicare UPIN