Provider Demographics
NPI:1730316282
Name:TANG, ANN ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:ELIZABETH
Last Name:TANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:40 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1205
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:2121 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2724
Practice Address - Country:US
Practice Address - Phone:636-949-2906
Practice Address - Fax:636-949-2914
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010019422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730316282Medicaid
MO1730316282Medicaid
MO064380026Medicare PIN