Provider Demographics
NPI:1457575722
Name:TANG, PAIGE (OD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:TANG
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 1:1673 BRANHAM LANE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-269-6861
Mailing Address - Fax:857-364-6092
Practice Address - Street 1:1673 BRANHAM LANE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118
Practice Address - Country:US
Practice Address - Phone:408-269-6861
Practice Address - Fax:857-364-6092
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13446TLG152W00000X
MA4365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400118582Medicare PIN
MAS400118580Medicare PIN