MEDICARE: DR. LOAN THI KIM LAO O.D.

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	152WP0200X	Pediatric Optometrist	7605TG	TX
2	152W00000X	Optometrist	7605TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB115266	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760794242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOAN THI KIM LAO O.D.

Provider Business Mailing Address
First Line	:	9191 KYSER WAY STE 602
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-1903
Country	:	US
Telephone Number	:	214-705-9433
Fax Number	:	214-705-9318

Provider Business Practice Location Address
First Line	:	9191 KYSER WAY
Second Line	:	SUITE # 600
City	:	FRISCO
State	:	TX
Zip	:	75033-1953
Country	:	US
Telephone Number	:	214-705-9433
Fax Number	:

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	06/19/2024

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