Provider Demographics
NPI:1992073704
Name:MARY ALICE A. TANGUAY OD PC
Entity type:Organization
Organization Name:MARY ALICE A. TANGUAY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-492-6588
Mailing Address - Street 1:PO BOX 116239
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-6239
Mailing Address - Country:US
Mailing Address - Phone:972-492-6588
Mailing Address - Fax:972-492-5337
Practice Address - Street 1:1850 E ROSEMEADE PKWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2637
Practice Address - Country:US
Practice Address - Phone:972-492-6588
Practice Address - Fax:972-492-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2904TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB142592Medicare PIN