Healthcare Provider Details

I. General information

NPI: 1063403061
Provider Name (Legal Business Name): THAO THACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N SHILOH RD STE. 103
GARLAND TX
75042-6610
US

IV. Provider business mailing address

PO BOX 453187
GARLAND TX
75045-3187
US

V. Phone/Fax

Practice location:
  • Phone: 214-703-9700
  • Fax: 214-703-9811
Mailing address:
  • Phone: 214-703-9700
  • Fax: 214-703-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberL6667
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberL6667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: