MEDICARE: DR. THUY NGOC YATH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1881	AZ

General Provider Information

NPI Number	:	1114278637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THUY NGOC YATH OD

Provider Business Mailing Address
First Line	:	4205 W ANTHEM WAY STE 101
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0445
Country	:	US
Telephone Number	:	623-879-3937
Fax Number	:	623-551-2051

Provider Business Practice Location Address
First Line	:	4205 W ANTHEM WAY STE 101
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0445
Country	:	US
Telephone Number	:	623-879-3937
Fax Number	:	623-551-2051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	04/21/2023

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