Provider Demographics
NPI:1184963878
Name:TANGO VISION, INC.
Entity type:Organization
Organization Name:TANGO VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:KON-WAI
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-336-9328
Mailing Address - Street 1:778 PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-5001
Mailing Address - Country:US
Mailing Address - Phone:415-336-9328
Mailing Address - Fax:
Practice Address - Street 1:215 BALSAM ST N
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-5814
Practice Address - Country:US
Practice Address - Phone:763-689-3774
Practice Address - Fax:763-689-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3266261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3266OtherOPTOMETRY LICENSE