Provider Demographics
NPI:1558640391
Name:ALBERT L TIEN OD INC
Entity type:Organization
Organization Name:ALBERT L TIEN OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:TIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-848-2821
Mailing Address - Street 1:2449 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2305
Mailing Address - Country:US
Mailing Address - Phone:323-728-7149
Mailing Address - Fax:323-728-7140
Practice Address - Street 1:2449 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2305
Practice Address - Country:US
Practice Address - Phone:323-728-7149
Practice Address - Fax:323-728-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFJ611AMedicare PIN