Healthcare Provider Details

I. General information

NPI: 1902353238
Provider Name (Legal Business Name): LOI THANH MAI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16106 BELLFLOWER BLVD
BELLFLOWER CA
90706-4606
US

IV. Provider business mailing address

16106 BELLFLOWER BLVD
BELLFLOWER CA
90706-4606
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-4716
  • Fax: 714-716-5525
Mailing address:
  • Phone: 714-724-1540
  • Fax: 714-716-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number894
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: