Provider Demographics
NPI:1295886323
Name:TIEN, MING-HSIN ALICE (OD)
Entity type:Individual
Prefix:
First Name:MING-HSIN
Middle Name:ALICE
Last Name:TIEN
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 1:2855 STEVENS CREEK BLVD
Mailing Address - Street 2:VALLEY FAIR SHOPPING CENTER #2429
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6709
Mailing Address - Country:US
Mailing Address - Phone:408-557-2890
Mailing Address - Fax:408-557-2885
Practice Address - Street 1:2855 STEVENS CREEK BLVD
Practice Address - Street 2:VALLEY FAIR SHOPPING CENTER #2429
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6709
Practice Address - Country:US
Practice Address - Phone:408-557-2890
Practice Address - Fax:408-557-2885
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU95016Medicare UPIN
CASDO120690Medicare ID - Type Unspecified