Provider Demographics
NPI:1992408355
Name:SALLY TAM PLLC
Entity type:Organization
Organization Name:SALLY TAM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:TAM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:469-899-2007
Mailing Address - Street 1:8710 W UNIVERSITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7826
Mailing Address - Country:US
Mailing Address - Phone:469-899-2007
Mailing Address - Fax:
Practice Address - Street 1:8710 W UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:469-899-2007
Practice Address - Fax:469-899-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty