Healthcare Provider Details

I. General information

NPI: 1548574361
Provider Name (Legal Business Name): LIEN-THU VAN DAO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHARLTON RD CENTER AT HOBBS BROOK
STURBRIDGE MA
01566-1505
US

IV. Provider business mailing address

59 WASHINGTON ST 1B
HAVERHILL MA
01832-5523
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-3300
  • Fax: 508-347-6303
Mailing address:
  • Phone: 978-374-0386
  • Fax: 978-372-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4806
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: