Individual
STEPHANIE TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Mailing address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG002630
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OEG002630
LICENSE
PA
Enumeration date
07/20/2012
Last updated
07/20/2012
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