1568633642 NPI number — ESTHER H. TAN, O.D. & ASSOCIATES, L.L.C.

Table of content: (NPI 1568633642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568633642 NPI number — ESTHER H. TAN, O.D. & ASSOCIATES, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESTHER H. TAN, O.D. & ASSOCIATES, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568633642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10624 S EASTERN AVE
Provider Second Line Business Mailing Address:
STE. A-200
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-2982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-434-2441
Provider Business Mailing Address Fax Number:
702-434-6409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 MARKS ST
Provider Second Line Business Practice Location Address:
STE. 1
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-434-2441
Provider Business Practice Location Address Fax Number:
702-434-6409
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TAN
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-434-2441

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  428 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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