Provider Demographics
NPI:1598250136
Name:TAN, JENNY (OD)
Entity Type:Individual
Prefix:MS
First Name:JENNY
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 1:301 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-7736
Mailing Address - Country:US
Mailing Address - Phone:281-427-7374
Mailing Address - Fax:281-427-6052
Practice Address - Street 1:301 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-7736
Practice Address - Country:US
Practice Address - Phone:281-427-7374
Practice Address - Fax:281-427-6052
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist