Provider Demographics
NPI:1588666481
Name:VANGUILDER, TANYA L (OD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:L
Last Name:VANGUILDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1668 E 2ND ST
Mailing Address - Street 2:STE B
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3168
Mailing Address - Country:US
Mailing Address - Phone:951-845-4749
Mailing Address - Fax:866-231-5968
Practice Address - Street 1:1668 E 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3168
Practice Address - Country:US
Practice Address - Phone:951-845-4749
Practice Address - Fax:951-845-3833
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12335T152W00000X
OR2934T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMM2343553OtherDEA NUMBER
CAMM2343553OtherDEA NUMBER
SD0123350Medicare PIN
V10779Medicare UPIN
ZZZ04039ZMedicare PIN