Provider Demographics
NPI:1689392342
Name:TAN, STEVEN MATTHEW MING-HAO (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MATTHEW MING-HAO
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 1:10047 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5323
Mailing Address - Country:US
Mailing Address - Phone:425-698-1891
Mailing Address - Fax:425-559-2101
Practice Address - Street 1:10047 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5323
Practice Address - Country:US
Practice Address - Phone:425-698-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35201TLG152W00000X
WAOD61330317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist