Provider Demographics
NPI:1912976127
Name:TUAN, CHENG YI (OD)
Entity Type:Individual
Prefix:
First Name:CHENG YI
Middle Name:
Last Name:TUAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:
Other - Last Name:TUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:338 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0207
Mailing Address - Country:US
Mailing Address - Phone:408-866-2020
Mailing Address - Fax:408-370-3937
Practice Address - Street 1:338 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0207
Practice Address - Country:US
Practice Address - Phone:408-866-2020
Practice Address - Fax:408-370-3937
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104320Medicare PIN
CAU76867Medicare UPIN