Healthcare Provider Details

I. General information

NPI: 1518249366
Provider Name (Legal Business Name): THAO MAI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 LAPALCO BLVD
MARRERO LA
70072-4382
US

IV. Provider business mailing address

20 NOTTOWAY DR
MARRERO LA
70072-5077
US

V. Phone/Fax

Practice location:
  • Phone: 504-341-0818
  • Fax:
Mailing address:
  • Phone: 504-723-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1530-567T
License Number StateLA

VIII. Authorized Official

Name: THAO MAI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 504-723-3546