Tieng Tan, O.D. Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT 13131 TPA Issued in CA

Legal business name

TIENG TAN, O.D. INC

Doing business as

ICU Optometry

Practice address

220 W Valley Blvd
Suite 202
San Gabriel, CA 91776-3738

Phone

(626) 458-5393

NPI assigned

Jan 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tieng Meng Tan, O.D.

Title

President

Phone

(626) 458-5393

Specialties & licenses 1

Addresses

Other names 1

• ICU Optometry Doing business as

Locations

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1952451015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W VALLEY BLVD",
            "address_2": "SUITE 202",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763738",
            "telephone_number": "626-458-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W VALLEY BLVD",
            "address_2": "SUITE 202",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763738",
            "telephone_number": "626-458-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIENG TAN, O.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "TIENG",
        "authorized_official_middle_name": "MENG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-458-5393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 13131 TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICU Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.