Active NPI
Tieng Meng Tan, O.D.
- Optometrist
- San Gabriel, CA
National Provider Identifier
1467561084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 13131
- Practice address
- 220 W Valley Blvd
202
San Gabriel, CA 91776-3738 - Phone
- (626) 827-9078
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 13131 | CA | Primary |
Addresses
Primary practice location
220 W Valley Blvd
202
San Gabriel, CA 91776-3738
Mailing address
5531 E Stearns St Ste a
Long Beach, CA 90815-3125
Phone (626) 827-9078
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070319000228 | CA | Practitioner - Optometry | 0042313736 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13131 | CA | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bunthay Chorn OD Inc | Optometrist | Current | Accepting new patients |
Locations
5531 E Stearns St
#A
Long Beach, CA 90815
Phone (562) 596-3838
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392768000000",
"number": "1467561084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5531 E STEARNS ST STE A",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908153125",
"telephone_number": "626-827-9078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 W VALLEY BLVD",
"address_2": "202",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917763738",
"telephone_number": "626-827-9078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "TIENG",
"middle_name": "MENG",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2014-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "13131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in San Gabriel, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.