Provider Demographics
NPI:1881081404
Name:TANYA OPTOMETRY CORPORATION
Entity type:Organization
Organization Name:TANYA OPTOMETRY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LETHUY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-362-6552
Mailing Address - Street 1:27001 MOULTON PKWY STE A100
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3626
Mailing Address - Country:US
Mailing Address - Phone:949-362-6552
Mailing Address - Fax:949-362-6566
Practice Address - Street 1:27001 MOULTON PKWY STE A100
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3626
Practice Address - Country:US
Practice Address - Phone:949-362-6552
Practice Address - Fax:949-362-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9953 TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty