Provider Demographics
NPI:1194902700
Name:DAVID W. TAM
Entity type:Organization
Organization Name:DAVID W. TAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-233-2875
Mailing Address - Street 1:13741 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3701
Mailing Address - Country:US
Mailing Address - Phone:510-233-2875
Mailing Address - Fax:510-233-2875
Practice Address - Street 1:13741 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3701
Practice Address - Country:US
Practice Address - Phone:510-233-2875
Practice Address - Fax:510-233-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7588TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24254ZMedicaid
CAZZZ24254ZMedicaid
CAZZZ24254ZMedicare PIN