Healthcare Provider Details

I. General information

NPI: 1053794222
Provider Name (Legal Business Name): THIEN-TRANG KATHERINE DAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S MISSOURI AVE
CLEARWATER FL
33756-4298
US

IV. Provider business mailing address

1211 46TH AVE N STE 100
ST PETERSBURG FL
33703-4411
US

V. Phone/Fax

Practice location:
  • Phone: 614-284-3791
  • Fax:
Mailing address:
  • Phone: 614-284-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC005095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: