Provider Demographics
NPI:1720648611
Name:TAN, KATY (OD)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:
Last Name:TAN
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 1:16550 NE 79TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2474
Mailing Address - Country:US
Mailing Address - Phone:808-276-8710
Mailing Address - Fax:
Practice Address - Street 1:10101 19TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4255
Practice Address - Country:US
Practice Address - Phone:425-338-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.OD.61397190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist