Tania Mantua & Matt H Siu OD a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

8008T Issued in CA

Legal business name

TANIA MANTUA & MATT H SIU OD A PROFESSIONAL CORPORATION

Practice address

7075 Redwood Blvd Ste F
Novato, CA 94945-4136

Phone

(415) 897-2997

Fax

(415) 898-3626

NPI assigned

Apr 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Lauren Olsen

Title

Office Manager

Phone

(415) 897-2997

Specialties & licenses 1

Addresses

Other names 1

• EyeWish Optometry Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christie Mackenzie, O.D.

  • Optometrist
  • Berkeley, CA
  • NPI 1124478128
  Medicare reassignment Care Compare group NPD
• Tania M. Mantua, O.D.

  • Optometrist
  • Novato, CA
  • NPI 1053337097
  Medicare reassignment Care Compare group NPD
• Matt Siu, O.D.

  • Optometrist
  • Novato, CA
  • NPI 1255783106
  Medicare reassignment Care Compare group NPD
• Lora G Pond, O.D.

  • Optometrist
  • Novato, CA
  • NPI 1972537124
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1376762229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7075 REDWOOD BLVD STE F",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454136",
            "telephone_number": "415-897-2997",
            "fax_number": "415-898-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7075 REDWOOD BLVD STE F",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454136",
            "telephone_number": "415-897-2997",
            "fax_number": "415-898-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANIA MANTUA & MATT H SIU OD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "415-897-2997",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8008T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EyeWish Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristina Svenson-Brown, P.T., C.H.T.
• John Tacchi
• Ana R Tafolla Rios
• Victoria A Tamayo
• Teresa Tang, MD
• Toni Tarpening
• Lauren Ann Tarrant, SP
• Tasker and Rowan Dental Corporation of Land Park
• Tasker and Rowan Dental Corporation of Marin
• Clarence L. Taylor, M.D.

• Optometrist in Novato, CA
• Providers in Novato, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.