MEDICARE: DR. BINH THANH DANG 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	3678	MN

General Provider Information

NPI Number	:	1407475403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BINH THANH DANG OD

Provider Business Mailing Address
First Line	:	180 KELLOGG BLVD E APT 1213
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-1590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1278 TOWN CENTRE DR STE 155
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-6404
Country	:	US
Telephone Number	:	612-851-0208
Fax Number	:

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

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	05/29/2020

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