Provider Demographics
NPI:1891495883
Name:TAN, CALEB KAI-HAY (OD)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:KAI-HAY
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 1:6795 E CALLE LA PAZ UNIT 11201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-9043
Mailing Address - Country:US
Mailing Address - Phone:510-209-6209
Mailing Address - Fax:
Practice Address - Street 1:7204 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1407
Practice Address - Country:US
Practice Address - Phone:520-416-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist