Healthcare Provider Details

I. General information

NPI: 1588634497
Provider Name (Legal Business Name): THANH-THAO THIEU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 LIMEKILN PIKE SUITE 2
CHALFONT PA
18914-3602
US

IV. Provider business mailing address

3425 LIMEKILN PIKE SUITE 2
CHALFONT PA
18914-3602
US

V. Phone/Fax

Practice location:
  • Phone: 215-997-0411
  • Fax:
Mailing address:
  • Phone: 215-997-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001198
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: